Peri-/Postoperative antientzündliche Therapie nach Kataraktoperation und refraktiver Chirurgie

Zusammenfassung

Die Kataraktoperation ist die häufigste Operation weltweit. Auch die refraktive Chirurgie erfreut sich steigender Beliebtheit. Obwohl die etablierten Eingriffe eine sehr niedrige Rate nicht infektiöser entzündlicher Komplikationen aufweisen, kann es zu postoperativen Veränderungen kommen. Relevant sind hier insbesondere das Makulaödem nach Kataraktchirurgie und die sterilen Entzündungen der Hornhaut nach refraktiver Hornhautchirurgie. Diese können durch eine Ingangsetzung von Entzündungskaskaden durch lokale Manipulation mit konsekutivem Einwandern von Entzündungszellen und entsprechender Reaktion des Gewebes entstehen. Aufgrund der hohen Anzahl an durchgeführten Eingriffen ist, trotz niedriger Inzidenz, eine hohe absolute Anzahl an Patienten von entsprechenden Veränderungen betroffen. Somit gilt es, durch entsprechende Anpassung der perioperativen Medikation, diese Inzidenz weiter zu reduzieren. Studien konnten zeigen, dass bei Kataraktoperationen sowohl das Risiko für ein postoperatives Makulaödem als auch für Schmerzen und Vorderkammerreiz bei Patienten mit perioperativer Applikation von nicht steroidalen Antirheumatika (NSAR) reduziert ist. Somit sollte eine perioperative Gabe von NSAR und Kortikosteroidtropfen erfolgen. Nach Hornhautchirurgie ist eine lokale Steroidtherapie zusätzlich empfohlen, da sie nach lamellärer refraktiver Hornhautchirurgie das Risiko für Hazebildung und tiefer lamellärer Keratitis (DLK) senkt.

Abstract

Cataract surgery is the most frequently performed surgery worldwide, and refractive surgery is gaining more and more popularity. Although they are rare, some possible complications of these procedures remain relevant for surgeons and patients. Macular edema in cataract surgery and sterile infections of the cornea after refractive corneal surgery can lower the visual outcome significantly. Such complications can occur due to activation of inflammation cascades as a result of local tissue manipulation during the surgery. Even though the incidence is very low, there are affected patients as a result of the high number of performed surgeries. Therefore, lowering those numbers with perioperative application of local eye drops is critical. Studies show a lower risk of macular edema, anterior chamber inflammation and postoperative pain in patients treated with perioperative non-steroidal anti-inflammatory drugs (NSAID). That is why a treatment with corticosteroid and NSAID drops should be prescribed. After lamellar corneal surgery, a local steroid application is recommended to lower the incidence of haze and deep lamellar keratitis (DLK).

Schlüsselwörter

Haze - Makulaödem - tiefe lamelläre Keratitis - DLK - Kataraktchirurgie - refraktive Chirurgie

Key words

haze - macular edema - deep lamellar keratitis - DLK - cataract surgery - refractive surgery

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