Zusammenfassung
Hintergrund
Die Ergebnisse der Kataraktchirurgie in vielen Gegenden Afrikas entsprechen bislang nicht den ehrgeizigen Zielsetzungen der WHO. Die superiore nahtlose Kernexpression (SICS) ist die Operation der Wahl in vielen Entwicklungsländern. Diese führt jedoch häufig zu einer deutlichen Zunahme des Hornhautastigmatismus. Eine Möglichkeit zur Verbesserung der Operationsergebnisse liegt in der Anwendung von temporalen Kleinschnitttechniken mit oder ohne Phakoemulsifikation (Phako).
Methoden
Es wurde eine retrospektive, nicht randomisierte Studie an einer Klinik im Südosten Kenias durchgeführt: 405 Augen wurden entweder mit temporaler Phako (n = 288) oder temporaler SICS (n = 117) mit Implantation einer starren PMMA-Linse operiert. Die zu bestimmenden Variablen waren: präoperativer Astigmatismus, operativ induzierter Astigmatismus, Visusergebnisse und Komplikationsrate.
Ergebnisse
Präoperativ betrug der mittlere Astigmatismus in allen Augen 1,1 dpt (Spanne von 0–6,28 dpt). Gegen-die-Regel-Astigmatismus (GdR; Mittelwert: 1,18 dpt) war mit 60,4% am häufigsten. Acht Wochen nach der Operation betrug der chirurgisch induzierte Astigmatismus 1,13 dpt (SD: 0,63) bei 92° für Phako und 1,11 dpt (SD: 0,56) bei 102° für SICS; 89,6% der Augen erreichten einen bestkorrigierten Visus von 0,3 oder besser (hiervon erreichten 82,7% diesen Visus auch unkorrigiert). Der Hauptgrund für einen postoperativ weiterhin reduzierten Visus waren okuläre Begleiterkrankungen.
Fazit
In diesem Studienkollektiv hatten die meisten Patienten einen präoperativen GdR-Astigmatismus, und ein routinemäßiger bzw. vorzugsweiser Wechsel auf temporale Inzisionen erscheint vorteilhaft. Die WHO empfiehlt, dass nach erfolgter Kataraktoperation nicht mehr als 10–20% der Augen einen Visus von weniger als 0,3 haben sollten. Diese Vorgabe wurde im Rahmen dieser Studie mit den vorgestellten Techniken erreicht.
Abstract
Background
The present outcomes of cataract surgery in Africa do not meet the recommendations of the World Health Organization. Superior manual small incision cataract surgery (SICS) is the operation of choice in many developing countries. However, there is good evidence that temporal incisions are more stable and cause less surgically induced astigmatism (SIA).
Methods
In a prospective, non-randomized study in an anterior segment clinic in the southeastern part of Kenya, 405 eyes were operated on using either temporal phacoemulsification (n = 288) or temporal SICS (n = 117) with implantation of a rigid intraocular lens (IOL). The main outcome variables were preexisting corneal astigmatism, SIA, visual outcomes and complication rates.
Results
Preoperatively, the mean astigmatism in all eyes was 1.1 diopters (D) ranging from 0 to 6.28 D. Against-the-rule astigmatism (ATR) (mean 1.18 D) was most common with 60.4%. After 8 weeks following surgery the mean SIA was 1.13 D (SD ±0.63 D) at 92° for phacoemulsification and 1.11 D (SD ±0.56 D) at 102° for SICS. Of the eyes 89.6% reached a best corrected visual acuity (BCVA) ≥ 0.3 and 82.7% reached this visual acuity also uncorrected. The main reasons for not reaching BCVA ≥ 0.3 were ocular comorbidities.
Conclusions
In the population studied most patients had preexisting ATR astigmatism and a switch to routine temporal incisions appeared beneficial. The World Health Organization recommends that poor (BCVA below 0.1) or borderline (BCVA below 0.3) outcomes after cataract surgery should not be more than 10–20%. This goal has been achieved in this study with the techniques presented.
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Briesen, S., Roberts, H. Katarakt-Operationsergebnisse durch temporale Kleinschnitttechniken mit und ohne Phakoemulsifikation. Ophthalmologe 109, 462–467 (2012). https://doi.org/10.1007/s00347-011-2513-8
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DOI: https://doi.org/10.1007/s00347-011-2513-8