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Pseudoexfoliationssyndrom und Kataraktchirurgie

Vermeidung und Behandlung von Komplikationen

Pseudoexfoliation syndrome and cataract surgery

Avoidance and treatment of complications

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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.

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Notes

  1. R. Menapace: Excision of rhexis phimosis using bipolar diathermy. Oertli Application Note 2005.

Literatur

  1. Menapace R (2005) Prevention of posterior capsule opacification. In: Koch DD, Kohnen T (Hrsg) Essentials in Ophthalmology. Springer, Berlin, S 101–122

  2. 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

    PubMed  CAS  Google Scholar 

  3. Davison JA (1993) Capsule contraction syndrome. J Cataract Refract Surg 19:582–589

    PubMed  CAS  Google Scholar 

  4. Freissler K, Küchle M, Naumann GO (1995) Spontaneous dislocation of the lens in pseudoexfoliation syndrome. Arch Ophthalmol 113(9):1095–1096

    Article  PubMed  CAS  Google Scholar 

  5. 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

    Article  PubMed  Google Scholar 

  6. 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)

    Google Scholar 

  7. 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

    Article  PubMed  CAS  Google Scholar 

  8. Nichamin LD (1993) Enlarging the pupil for cataract extraction using flexible nylon iris retractors. J Cataract Refract Surg 19:793–796

    PubMed  CAS  Google Scholar 

  9. 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

    Article  PubMed  Google Scholar 

  10. Tognetto D, Agolini G, Grandi G, Ravalico G (2001) Iris alteration using mechanical iris retractors. J Cataract Refract Surg 27:1703–1705

    Article  PubMed  CAS  Google Scholar 

  11. 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

    PubMed  Google Scholar 

  12. Menapace R, Di Nardo S (2006) Aspiration curette for anterior capsule polishing: laboratory and clinical evaluation. J Cataract Refract Surg 32:1997–2003

    Article  PubMed  Google Scholar 

  13. 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

    Article  PubMed  Google Scholar 

  14. 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

    Article  PubMed  Google Scholar 

  15. 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

    Google Scholar 

  16. Menapace R, Findl O, Georgopoulos M et al (2000) The capsular tension ring: designs, applications, and techniques. J Cataract Refract Surg 26:898–912

    Article  PubMed  CAS  Google Scholar 

  17. Menapace R (2008) „Capsular tension rings“. In: Koch DD, Kohnen T (Hrsg) Essentials in ophthalmology. Springer, Berlin, S 27–44

  18. 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

    Article  PubMed  Google Scholar 

  19. 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

    PubMed  CAS  Google Scholar 

  20. 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

    Article  PubMed  Google Scholar 

  21. 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

    Article  PubMed  Google Scholar 

  22. Henderson BA, Kim JY (2007) Modified capsular tension ring for cortical removal after implantation. J Cataract Refract Surg 33:1688–1690

    Article  PubMed  Google Scholar 

  23. 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

    Article  PubMed  Google Scholar 

  24. Levy J, Klemperer I, Lifshitz T (2005) Posteriorly dislocated capsular tension ring. Ophthalmic Surg Lasers Imaging 36:416–418

    PubMed  Google Scholar 

  25. 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)

    Google Scholar 

  26. 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

    Article  PubMed  CAS  Google Scholar 

  27. Hasanee K, Butler M, Ahmed II (2006) Capsular tension rings and related devices: current concepts. Curr Opin Ophthalmol 17:31–41

    PubMed  Google Scholar 

  28. 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

    Article  PubMed  Google Scholar 

  29. 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

    Article  Google Scholar 

  30. 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)

    Google Scholar 

  31. 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

    PubMed  CAS  Google Scholar 

  32. 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

    PubMed  CAS  Google Scholar 

  33. Waheed K, Eleftheriadis H, Liu C (2001) Anterior capsular phimosis in eyes with a capsular tension ring. J Cataract Refract Surg 27:1688–1690

    Article  PubMed  CAS  Google Scholar 

  34. 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

    Article  PubMed  Google Scholar 

  35. 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

    Article  PubMed  Google Scholar 

  36. Liu CS, Eleftheriadis H (2001) Multiple capsular tension rings for the prevention of capsular contraction syndrome. J Cataract Refract Surg 27:342–343

    Article  PubMed  CAS  Google Scholar 

  37. 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

    Article  PubMed  Google Scholar 

  38. Moreno-Montañés J, Heras H, Fernández-Hortelano A (2006) Dislocated capsular tension ring. Ophthalmology 113:2114–2115

    Article  PubMed  Google Scholar 

  39. Ahmed II, Chen SH, Kranemann C, Wong DT (2005) Surgical repositioning of dislocated capsular tension rings. Ophthalmology 112:1725–1733

    Article  PubMed  Google Scholar 

  40. Chang DF (2004) Siepser slipknot for McCannel iris-suture fixation of subluxated intraocular lenses. J Cataract Refract Surg 30(6):1170–1176

    Article  PubMed  Google Scholar 

  41. Duffey RJ, Holland EJ, Agapitos PJ, Lindstrom RL (1989) Anatomic study of transsclerally sutured intraocular lens implantation. Am J Ophthalmol 15(108):300–309

    Google Scholar 

  42. Hoffman RS, Fine ICH, Packer M (2006) Scleral fixation without conjunctival dissection. J Cataract Refract Surg 32:1907–1912

    Article  PubMed  Google Scholar 

  43. 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

    Article  PubMed  CAS  Google Scholar 

  44. 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

    PubMed  Google Scholar 

  45. 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

    Article  PubMed  Google Scholar 

  46. 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

    Article  PubMed  CAS  Google Scholar 

  47. 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

    Article  PubMed  Google Scholar 

  48. Saravanan VR, Singh G, Narendran V, Sathyan P (2006) Managing the IOL-CTR-CB complex. J Cataract Refract Surg 32:1898–1899

    Article  PubMed  Google Scholar 

  49. 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

    Article  PubMed  Google Scholar 

  50. 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

    Article  PubMed  Google Scholar 

  51. 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

    Article  Google Scholar 

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  1. Universitätsklinik für Augenheilkunde und Optometrie, Allgemeines Krankenhaus – Universitätskliniken Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich

    R. Menapace

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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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