Endothelzellverlust bei phaken Intraokularlinsen

Zusammenfassung

Obwohl die Sicherheit der phaken Intraokularlinsen (pIOLs) über eine bereits 70-jährige Entwicklungsgeschichte kontinuierlich verbessert wurde, können hohe Endothelzellverluste auch bei den aktuellen pIOL-Modellen auftreten. Die Studienergebnisse zeigen, dass die Entfernung einer pIOL zum Hornhautendothel eine entscheidende Rolle beim Endothelzellverlust spielt. Allein deswegen werden bei den Vorderkammerlinsen tendenziell höhere Endothelzellverluste beobachtet als bei den Hinterkammerlinsen. Eine ausreichende präoperative Vorderkammertiefe ist essenziell, zumindest bei den irisfixierten pIOLs, um eine sichere Distanz zum Endothel zu gewährleisten. Die Vorderkammer wird jedoch mit zunehmendem Alter flacher und es kann deswegen sinnvoll sein, das Patientenalter bei den Sicherheitskriterien mitzuberücksichtigen. Obwohl der Endothelzellverlust bei den aktuellen pIOL-Modellen i. d. R. gering ist, sind regelmäßige Kontrollen mit Messung der Endothelzelldichte aufgrund großer interindividueller Unterschiede bei den Patienten mit pIOLs nach wie vor unverzichtbar. Falls ein höherer Endothelzellverlust beobachtet wird als erwartet und die nachfolgenden Kontrollen die Tendenz bestätigen, soll die pIOL rechtzeitig explantiert werden. Hierbei ist die Endothelreserve individuell zu betrachten, indem man das Patientenalter, den physiologischen Endothelzellverlust sowie den Verlust durch weitere Operationen berücksichtigen sollte. Bei einer sorgfältigen Indikationsstellung und einer langfristigen Patientenbetreuung stellen die pIOLs nach wie vor eine sichere Behandlungsoption dar.

Schlüsselwörter

refraktive Chirurgie - phake Intraokularlinsen - pIOL - Endothelzellverlust - Endothel - Hornhaut

Publication History

Received: 31 January 2023

Accepted: 06 November 2023

Article published online:
19 January 2024

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