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Kataraktoperation

Effekt auf den hinteren Augenabschnitt

Cataract surgery

Effect on the posterior segment of the eye

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Zusammenfassung

Die Kataraktoperation ist ein sicherer Eingriff mit niedriger Komplikationsrate und guter Erfolgsaussicht. Dennoch beeinflusst sie die Physiologie des Auges. Akut werden Entzündungsmediatoren freigesetzt, intraoperative Druckschwankungen und Verformungen des Auges können Mikrotraumen hervorrufen und die Durchblutung beeinträchtigen. Postoperativ verändern sich die Diffusionsbarrieren und die Geometrie der intraokularen Räume. Insbesondere der Glaskörper unterliegt über die Jahre vermehrten Destruktionen. Klinisch ist das pseudophake zystoide Makulaödem nach Kataraktoperation bekannt. Mehrere Studien bestätigten eine gewisse Progredienz einer diabetischen Retinopathie, v. a. eines diabetischen Makulaödems. Für das Fortschreiten einer Makuladegeneration scheint die Kataraktoperation keine große Rolle zu spielen, das Risiko für eine Netzhautablösung bei Pseudophakie steigt jedoch über mindestens 10 Jahre erheblich an. Die Berücksichtigung besonderer Risikofaktoren bei der Indikationsstellung kann den Eingriff noch sicherer machen.

Abstract

Cataract surgery is a safe procedure with a high patient satisfaction rate. However, pseudophakia changes the physiology of the eye and immediate changes include release of inflammatory cytokines. Deformation of the globe and intraoperative fluctuations of intraocular pressure may induce microlesions and alterations of ocular perfusion. The barrier function between the anterior and the posterior segment is compromised after surgery and the geometry of the intraocular chambers changes. Especially the vitreous body is subject to increased destruction during the years after surgery. The occurrence of pseudophakic cystoid macular edema after cataract surgery is a well known complication. Several studies have described a progression of diabetic retinopathy, especially of diabetic macular edema after cataract surgery. In contrast cataract surgery does not seem to have a significant impact on the progression of age-related macular degeneration. However the risk for retinal detachment is significantly increased in pseudophakia for at least 10 years after surgery. Awareness of special risk factors can make cataract surgery, one of the most effective procedures in medicine, even safer.

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Authors and Affiliations

  1. Augenklinik, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93042, Regensburg, Deutschland

    W.A. Herrmann & H. Helbig

  2. Department of Ophthalmology, University of Liverpool, Liverpool, UK

    H. Heimann

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  1. W.A. Herrmann
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  2. H. Heimann
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  3. H. Helbig
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Correspondence to W.A. Herrmann.

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Herrmann, W., Heimann, H. & Helbig, H. Kataraktoperation . Ophthalmologe 107, 975–986 (2010). https://doi.org/10.1007/s00347-010-2236-2

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