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Passagere Visusminderung nach photodynamischer Therapie

Ein refraktives Problem?

Transient visual decrease after photodynamic therapy

A refractive problem?

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Zusammenfassung

Hintergrund

Nach photodynamischer Therapie (PDT) berichten Patienten wiederholt von einer vorübergehenden Sehverschlechterung in der ersten postoperativen Woche.

Patienten und Methode

Vor, 2 Tage und eine Woche nach PDT wurden der Visus (mit bestkorrigierter Refraktion) und die Refraktionsänderung untersucht und eine A-Scan-Ultraschallbiometrie durchgeführt. Insgesamt 53 PDT-Behandlungen bei 24 Augen konnten in diese prospektive Studie aufgenommen werden. In 3 Fällen erfolgten zusätzlich lineare und dreidimensionale optische Kohärenztomographien der Makula.

Ergebnisse

Der Refraktionsvergleich aller 53 Behandlungen wies bei 43% (n=23) am zweiten postoperativen Tag eine Hyperopisierung von durchschnittlich +0,35 dpt nach, welche sich bis zur Untersuchung eine Woche nach PDT auf +0,07 dpt reduzierte. Der Visusverlauf zeigte nach 2 Tagen mit der jeweils besten Korrektur bei 68% der Fälle (36/53) einen konstanten oder besseren Visus. Zu einer Visusreduktion kam es in 32% (17/53), eine Woche später konnte eine solche nur noch bei 23% (12/53) dokumentiert werden. Die Biometrie zeigte am 2. postoperativen Tag eine Verkürzung der Hornhaut-Retina-Distanz von durchschnittlich 0,13 mm. Dies entsprach der gemessenen Hyperopisierung von durchschnittlich 0,35 dpt. Das OCT zeigte ein transientes postoperatives Ödem im Bereich des behandelten Areals.

Schlussfolgerungen

Eine Hyperopisierung am zweiten postoperativen Tag nach PDT trat bei 43% auf. Die subjektive postoperative Visusminderung konnte meist durch Korrektur der Hyperopisierung ausgeglichen werden. Ein Ödem im behandelten Netzhautareal scheint kausal für diese verantwortlich zu sein.

Abstract

Background

After photodynamic therapy (PDT) some patients complain about a transient decrease of visual acuity during the first postoperative week.

Patients and Methods

Prior to and at 2 days and 1 week after PDT the following parameters were measured: (1) best corrected visual acuity (VA), (2) changes in refraction, and (3) A scan ultrasound biometry was carried out. Linear and 3-D optical coherence tomography was performed in three cases. A total of 53 PDT treatments were followed-up in 24 patients.

Results

Comparison of the pre- and postoperative refraction demonstrated a mean hyperopic shift of +0.35 diopters (dpt) in 43% of treatments (23/53) on the second postoperative day. The hyperopic shift reduced to +0.07 dpt after 1 week. The best corrected VA remained stable or was even better in 68% (36/53) on the second postoperative day. A decrease in VA could be noticed in 32% (17/53) at this time which declined to 23% (12/53) after 1 week. Measurement of the cornea-retina distance using A-scan ultrasound biometry disclosed a mean axial reduction of 0,13 mm at the second postoperative day. This correlates closely with an average hyperopic shift of 0,35 dpt. OCT examination disclosed a transient macular edema in the treated retinal areas.

Conclusions

A transient hyperopic shift can be measured in 43% on the second postoperative day. The subjective decrease in visual acuity measured over the postoperative days was mainly due to a transient hyperopic shift in our patients. OCT findings disclosed a transient macular edema of the retina treated with PDT, which may relate to a hyperopic shift.

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Authors and Affiliations

  1. Klinik für Augenheilkunde, Philipps-Universität, Marburg

    S. Mennel, C. H. Meyer & S. Hörle

  2. Augenabteilung, Akademisches Lehrkrankenhaus, Feldkirch, Österreich

    S. Mennel, N. Hausmann & S. Peter

  3. Klinik für Augenheilkunde, Philipps-Universität, Robert-Koch-Straße 4, 35037 , Marburg

    S. Mennel

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  1. S. Mennel
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  2. N. Hausmann
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  3. C. H. Meyer
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  4. S. Hörle
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Correspondence to S. Mennel.

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Mennel, S., Hausmann, N., Meyer, C.H. et al. Passagere Visusminderung nach photodynamischer Therapie. Ophthalmologe 102, 58–63 (2005). https://doi.org/10.1007/s00347-004-1065-6

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  • DOI: https://doi.org/10.1007/s00347-004-1065-6

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