Zusammenfassung
Hintergrund
Die refraktive Laserchirurgie der Hornhaut hat sich in den letzten 3 Jahrzehnten von der experimentellen Forschung zu einem der weltweit am meisten angewandten Verfahren gemausert.
Ergebnisse
Bei den refraktiven Ergebnissen ist eine weitere Verbesserung nicht mehr zu erwarten, da die Treffergenauigkeit der modernen Laser-in-situ-Keratomileusis (LASIK) vergleichbar der Reproduzierbarkeit der manifesten Refraktion ist. Einer der Sterne am refraktiven Himmel ist die stromale Lentikelextraktion mithilfe von Femtosekundenlasern. Deren Weiterentwicklung ist ins Stocken geraten, und auch das Problem der Nachoperation ist noch pendent.
Ausblick
Obwohl der Fortschritt in der refraktiven Chirurgie sich verlangsamt hat, sind auch in den nächsten Jahren noch wichtige Entwicklungen zu erwarten.
Abstract
Background
Within less than 30 years refractive laser surgery has been developed from an experimental technique to one of the most frequently applied procedures in ophthalmology worldwide.
Results
Regarding the success rate of refractive results, myopia correction has reached a level (95 % within ± 0.5 D) that is comparable to manifest refraction so that there is not much room for improvement. The most recently developed technique is femtosecond laser lenticule extraction which was introduced in 2007 in Germany. Early clinical results were very promising but the awaited bilateral comparative studies are still lacking. Although new laser types that will be able to provide improved profiles are on the horizon, the problem of reoperations has not yet been solved. Topography-guided ablation is notoriously plagued by undercorrection so that topography-guided treatment is planned as a two step-procedure. The reason for the undercorrection is the leveling effect of the epithelium.
Perspectives
The evolution of refractive surgery has slowed down during the last years, however, some important innovations are at the advent.
Literatur
Schumacher S, Seiler T, Cummings A et al (2012) Optical ray tracing-guided laser in situ keratomileusis for moderate to high myopic astigmatism. J Cataract Refract Surg 38:28–34
Tomita M, Watabe M, Yukawa S et al (2013) Supplementary effect of static cyclotorsion compensation with dynamic cyclotorsion compensation on the refractive and visual outcomes of laser in situ keratomileusis for myopic astigmatism. J Cataract Refract Surg 39:752–758
Waring GO III, Lynn MJ, Gelender H et al (1985) Results of the prospective evaluation of radial keratotomy (PERK) study one year after surgery. Ophthalmology 92:177–198
Salah T, Waring GO III, el-Maghraby A et al (1995) Excimer laser in-situ keratomileusis (LASIK) under a corneal flap for myopia of 2 to 20 D. Trans Am Ophthalmol Soc 93:163–183
Tomita M, Watabe M, Yukawa S et al (2014) Safety, efficacy, and predictability of laser in situ keratomileusis to correct myopia or myopic astigmatism with a 750 Hz scanning-spot laser system. J Cataract Refract Surg 40:251–258
Shaheen MS, Massoud TH, Ezzeldin H, Khalifa MA et al (2013) Four-year visual, refractive, and contrast sensitivity outcomes after wavefront-guided myopic LASIK using an advanced excimer laser platform. J Refract Surg 29:816–822
Zhang J, Zhou YH, Li R, Tian L (2013) Visual performance after conventional LASIK and wavefront-guided LASIK with iris-registration: results at 1 year. Int J Ophthalmol 18:498–504
Tomita M, Waring GO IV, Magnago T, Watabe M (2013) Clinical results of using a high-repetition-rate excimer laser with an optimized ablation profile for myopic correction in 10. 235 eyes. J Cataract Refract Surg 39:1543–1549
Sáles CS, Manche EE (2013) One-year outcomes from a prospective, randomized, eye-to-eye comparison of wavefront-guided and wavefront-optimized LASIK in myopes. Ophthalmology 120:2396–2402
MacKenzie GE (2008) Reproducibility of sphero-cylindrical prescriptions. Ophthalmic Physiol Opt 28:143–150
Neuhann IM, Lege BA, Bauer M et al (2010) Static and dynamic rotational eye tracking during LASIK treatment of myopic astigmatism with the Zyoptix laser platform and Advanced Control Eye Tracker. J Refract Surg 26:17–27
Alio JL, Pachkoria K, El Aswad A, Plaza-Puche AB (2013) Laser-assisted in situ keratomileusis in high mixed astigmatism with optimized, fast-repetition and cyclotorsion control excimer laser. Am J Ophthalmol 155:829–836
Ivarsen A, Næser K, Hjortdal J (2013) Laser in situ keratomileusis for high astigmatism in myopic and hyperopic eyes. J Cataract Refract Surg 39:74–80
Stern D, Schoenlein RW, Puliafito CA et al (1989) Corneal ablation by nanosecond, picosecond, and femtosecond lasers at 532 and 625 nm. Arch Ophthalmol 107:587–592
Lubatschowski H, Maatz G, Heisterkamp A et al (2000) Application of ultrashort laser pulses for intrastromal refractive surgery. Graefes Arch Clin Exp Ophthalmol 238:33–39
Sekundo W, Kunert K, Russmann C et al (2008) First efficacy and safety study of femtosecond lenticule extraction for the correction of myopia: six-month results. J Cataract Refract Surg 34:1513–1520
Demirok A, Agca A, Ozgurhan EB et al (2013) Femtosecond lenticule extraction for correction of myopia: a 6 month follow-up study. Clin Ophthalmol 7:1041–1047
Vestergaard A, Ivarsen AR, Asp S, Hjortdal JØ (2012) Small-incision lenticule extraction for moderate to high myopia: predictability, safety, and patient satisfaction. J Cataract Refract Surg 38:2003–2010
Gibralter R, Trokel SL (1994) Correction of irregular astigmatism with the excimer laser. Ophthalmology 101:1310–1314
Holland S, Lin DT, Tan JC (2013) Topography-guided laser refractive surgery. Curr Opin Ophthalmol 24:302–309
Reinstein DZ, Archer TJ, Gobbe M (2012) Refractive and topographic errors in topography-guided ablation produced by epithelial compensation predicted by 3D Artemis VHF digital ultrasound stromal and epithelial thickness mapping. J Refract Surg 28:657–663
Danksagung
Den Herren Dipl. Ing. Wuellner und Donitzki sei gedankt für die produktive Zusammenarbeit und die Abb. 1 b und Abb. 3 a. Ich danke auch Herrn Dr. J. Kanellopoulos, Athen, für die Abb. 3 b.
Einhaltung ethischer Richtlinien
Interessenkonflikt. T. Seiler ist wissenschaftlicher Berater für Alcon-Wavelight. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
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Seiler, T. Innovationen in der refraktiven Laserchirurgie 2014. Ophthalmologe 111, 539–542 (2014). https://doi.org/10.1007/s00347-013-2993-9
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DOI: https://doi.org/10.1007/s00347-013-2993-9