Zusammenfassung
Augen mit Pseudoexfoliationssyndrom zeigen häufig ungenügende Mydriase, Zonulaschwäche und erhöhte fibrotische Kapselschrumpfung. Dies kann die Kataraktoperation als solche erschweren, aber auch postoperativ zu Komplikationen führen wie Rhexisovalisierung und -phimose (Kapselkontraktionssyndrom) oder progrediente Lockerung der Zonula mit finaler Spontandislokation des Kapselsack-Implantat-Komplexes (KIKs). Um dies zu vermeiden oder zu korrigieren, stehen spezielle Techniken und Implantate zur Verfügung. Prophylaktisch können intrakamerales Adrenalin und retroiridale Kapsulorhexis, Irisretraktoren und -dilatatoren, Vorderkapselpolitur, diverse Kapselspann- und -knickringmodelle, bimanuelle Kapselimplantation, Kapselsackstabilisierung durch Irisretraktoren oder Kapselsegmente und Sekundärrhexis eingesetzt werden. Rhexisphimosen können mittels spezieller Elektrodiathermiesonde exzidiert, ein subluxierter KIK in toto oder nur die ausgeschälte Linse im Sulkus, Letztere auch an der Irisrückfläche nahtrefixiert werden. In den Glaskörperraum luxierte KIKs können gehoben, ebenso fixiert werden. Alternativ kann der KIK explantiert und entweder durch eine sulkusgenähte Hinterkammer- oder durch eine kammerwinkel- oder irisgestützte Vorderkammerlinse ersetzt werden.
Abstract
Eyes with pseudoexfoliation syndrome often exhibit insufficient mydriasis, zonular weakness and pronounced fibrotic capsular shrinkage. This may make cataract surgery as such difficult but also leads to postoperative complications, such as rhexis ovalization or phimosis (capsule contraction syndrome) or progressive zonular weakening with final spontaneous dislocation of the capsule-implant complex (CIC). To avoid or correct for this special techniques and implants may be used: as prophylaxis, intracameral adrenalin and retroiridal capsulorhexis, iris retractors or dilators, various models of capsular tension and bending rings, bimanual capsule ring implantation, capsular bag stabilization with iris retractors or segments and secondary capsulorhexis may be used. Rhexis phimosis may be excised by a special diathermic probe, a subluxated CIC may be sutured to the sclera either in toto or the lens only after removal from the capsule bag, the latter also to the posterior iris surface. When luxated into the vitreous cavity, the CIC may be lifted to the iris plane and refixed as described or exchanged for a new lens sutured into the sulcus or an angle or iris-supported anterior chamber lens.
Notes
R. Menapace: Excision of rhexis phimosis using bipolar diathermy. Oertli Application Note 2005.
Literatur
Menapace R (2005) Prevention of posterior capsule opacification. In: Koch DD, Kohnen T (Hrsg) Essentials in Ophthalmology. Springer, Berlin, S 101–122
Joo CK, Shin JA, Kim JH (1996) Capsular opening contraction after continuous curvilinear capsulorhexis and intraocular lens implantation. J Cataract Refract Surg 22:585–590
Davison JA (1993) Capsule contraction syndrome. J Cataract Refract Surg 19:582–589
Freissler K, Küchle M, Naumann GO (1995) Spontaneous dislocation of the lens in pseudoexfoliation syndrome. Arch Ophthalmol 113(9):1095–1096
Hayashi K, Hirata A, Hayashi H (2007) Possible predisposing factors for in-the-bag and out-of-the-bag intraocular lens dislocation and outcomes of intraocular lens exchange surgery. Ophthalmology 114:969–975
Zech JC, Tanniére P, Denis P, Trepsat C (1999) Posterior chamber intraocular lens dislocation with the bag. J Cataract Refract Surg 25:1168–1169 (Comment in: J Cataract Refract Surg 2000; 26:476–477)
Yasuda A, Ohkoshi K, Orihara Y et al (2000) Spontaneous luxation of encapsulated intraocular lens onto the retina after a triple procedure of vitrectomy, phacoemulsification, and intraocular lens implantation. Am J Ophthalmol 130:836–837
Nichamin LD (1993) Enlarging the pupil for cataract extraction using flexible nylon iris retractors. J Cataract Refract Surg 19:793–796
Chang DF (2008) Use of Malyugin pupil expansion device for intraoperative floppy-iris syndrome: results in 30 consecutive cases. J Cataract Refract Surg 34:835–841
Tognetto D, Agolini G, Grandi G, Ravalico G (2001) Iris alteration using mechanical iris retractors. J Cataract Refract Surg 27:1703–1705
Sacu S, Menapace R, Wirtitsch M et al (2004) Effect of anterior capsule polishing on fibrotic capsule opacification: three-year results. J Cataract Refract Surg 30:2322–2327
Menapace R, Di Nardo S (2006) Aspiration curette for anterior capsule polishing: laboratory and clinical evaluation. J Cataract Refract Surg 32:1997–2003
Menapace R, Wirtitsch M, Findl O et al (2005) Effect of anterior capsule polishing on PCO and YAG capsulotomy rate: a three-year randomized trial. J Cataract Refract Surg 31:2067–2075
Liu X, Cheng B, Zheng D et al (2010). Role of anterior capsule polishing in residual LEC proliferation. J Cataract Refract Surg 36:208–214
Menapace R (2008) Posterior capsulorhexis combined with optic buttonholing: an alternative to standard in-the-bag implantation of sharp-edged intraocular lenses? A critical analysis of 1000 consecutive cases. Graefes’s Archives Clin Exp Ophthalmol 246:787–801
Menapace R, Findl O, Georgopoulos M et al (2000) The capsular tension ring: designs, applications, and techniques. J Cataract Refract Surg 26:898–912
Menapace R (2008) „Capsular tension rings“. In: Koch DD, Kohnen T (Hrsg) Essentials in ophthalmology. Springer, Berlin, S 27–44
Lee DH, Shin SC, Joo CK (2002) Effect of a capsular tension ring on intraocular lens decentration and tilting after cataract surgery. J Cataract Refract Surg 28:843–846
Sun R, Gimbel HV (1998) In vitro evaluation of the efficay of the capsular tension ring for managing zonular dialysis in cataract surgery. Ophthalmic Surg Lasers 29:502–505
Pandey SK, Werner L, Wilson ME Jr et al (2004) Capsulorhexis ovaling and capsular bag stretch after rigid and foldable intraocular lens implantation: experimental study in pediatric human eyes. J Cataract Refract Surg 30:2183–2191
Ahmed II, Cionni RJ, Kranemann C, Crandall AS (2005) Optimal timing of capsular tension ring implantation: Miyake-Apple video analysis. J Cataract Refract Surg 31:1809–1913
Henderson BA, Kim JY (2007) Modified capsular tension ring for cortical removal after implantation. J Cataract Refract Surg 33:1688–1690
Menapace R, Sacu S, Georgopoulos M et al (2008) Efficacy and safety of capsular bending ring implantation for after-cataract prevention: 3-year results of a randomized clinical trial. J Cataract Refract Surg 34:1318–1328
Levy J, Klemperer I, Lifshitz T (2005) Posteriorly dislocated capsular tension ring. Ophthalmic Surg Lasers Imaging 36:416–418
Angunawela RI, Little B (2007) Fish-tail technique for capsular tension ring insertion. J Cataract Refract Surg 33:767–769 (Comment in: J Cataract Refract Surg 33:1840)
Lee V, Bloom P (1999) Microhook capsule stabilization for phacoemulsification in eyes with pseudoexfoliation-syndrome-induced lens instability. J Cataract Refract Surg 25:1567–1570
Hasanee K, Butler M, Ahmed II (2006) Capsular tension rings and related devices: current concepts. Curr Opin Ophthalmol 17:31–41
Oner FH, Kocak N, Saatci AO (2006) Dislocation of capsular bag with intraocular lens and capsular tension ring. J Cataract Refract Surg 32:1756–1758
Scherer M, Bertelmann E, Rieck P (2007) Late spontaneous in-the-bag IOL and CTR dislocation in PEX syndrome. J Cataract Refract Surg 33:672–675
Jehan FS, Mamalis N, Crandall AS (2001) Spontaneous late dislocation of intraocular lens within the capsular bag in pseudoexfoliation patients. Ophthalmology 108:1727–1731 (Comment in: Ophthalmology 2002;109:1951–1952)
Cionni RJ, Osher RH (1998) Management of profound zonular dialysis or weakness with a new endocapsular ring designed for scleral fixation. J Cataract Refract Surg 24:1299–1306
Strenn K, Menapace R, Vass C (1997) Capsular bag shrinkage after implantation of an open-loop silicone lens and a PMMA capsule tension ring. J Cataract Refract Surg 23:1543–1547
Waheed K, Eleftheriadis H, Liu C (2001) Anterior capsular phimosis in eyes with a capsular tension ring. J Cataract Refract Surg 27:1688–1690
Moreno-Montañés J, Sánchez-Tocino H, Rodriguez-Conde R (2002) Complete anterior capsule contraction after phacoemulsification with acrylic intraocular lens and endocapsular ring implantation. J Cataract Refract Surg 28:717–719
Moreno-Montañés J, Sánchez-Tocino H, Rodriguez-Conde R (2002) Complete anterior capsule contraction after phacoemulsification with acrylic intraocular lens and endocapsular ring implantation. J Cataract Refract Surg 28:717–719
Liu CS, Eleftheriadis H (2001) Multiple capsular tension rings for the prevention of capsular contraction syndrome. J Cataract Refract Surg 27:342–343
Moreno-Montañés J, Heras H, Fernández-Hortelano A (2005) Surgical treatment of a dislocated intraocular lens-capsular bag-capsular tension ring complex. J Cataract Refract Surg 31:270–273
Moreno-Montañés J, Heras H, Fernández-Hortelano A (2006) Dislocated capsular tension ring. Ophthalmology 113:2114–2115
Ahmed II, Chen SH, Kranemann C, Wong DT (2005) Surgical repositioning of dislocated capsular tension rings. Ophthalmology 112:1725–1733
Chang DF (2004) Siepser slipknot for McCannel iris-suture fixation of subluxated intraocular lenses. J Cataract Refract Surg 30(6):1170–1176
Duffey RJ, Holland EJ, Agapitos PJ, Lindstrom RL (1989) Anatomic study of transsclerally sutured intraocular lens implantation. Am J Ophthalmol 15(108):300–309
Hoffman RS, Fine ICH, Packer M (2006) Scleral fixation without conjunctival dissection. J Cataract Refract Surg 32:1907–1912
Szurman P, Petermeier K, Aisenbrey S et al (2010) Z-suture: a new knotless technique for transscleral suture fixation of intraocular implants. Br J Ophthalmol 94:167–169
Agarwal A, Trivedi RH, Jacob S et al (2007) Management of posteriorly dislocated capsular tension ring with vitrectomy using a „chandelier“ illumination system. Clin Ophthalmol 1:285–288
Scharioth GB, Prasad S, Georgalas I et al (2010) Intermediate results of sutureless intrascleral posterior chamber intraocular lens fixation. J Cataract Refract Surg 36:254–259
Kumar DA, Agarwal A, Prakash G et al (2010) Glued posterior chamber IOL in eyes with deficient capsular support: a retrospective analysis of 1-year post-operative outcomes. Eye 24:1143–1148
Lim MC, Jap AH, Wong EY (2006) Surgical management of late dislocated lens capsular bag with intraocular lens and endocapsular tension ring. J Cataract Refract Surg 32:533–535
Saravanan VR, Singh G, Narendran V, Sathyan P (2006) Managing the IOL-CTR-CB complex. J Cataract Refract Surg 32:1898–1899
Deka S, Deka A, Bhattacharjee H (2006) Management of posteriorly dislocated endocapsular tension ring and intraocular lens complex. J Cataract Refract Surg 32:887–889
Shingleton BJ, Laul A, Nagao K et al (2008) Effect of phacoemulsification on intraocular pressure in eyes with pseudoexfoliation: single-surgeon series. J Cataract Refract Surg 34:1834–1841
Conway RM, Schlötzer-Schrehardt U, Küchle M, Naumann GOH (2004) Pseudoexfoliation syndrome: pathological manifestations of relevance to intraocular surgery. Clin Exp Ophthalmol 32:199–210
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Menapace, R. Pseudoexfoliationssyndrom und Kataraktchirurgie. Ophthalmologe 109, 976–989 (2012). https://doi.org/10.1007/s00347-012-2533-z
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DOI: https://doi.org/10.1007/s00347-012-2533-z