Die Behandlung der Katarakt im Kindesalter

 

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Zusammenfassung

Die angeborene und frühkindliche Katarakt gehören zu den häufigsten organischen Ursachen kindlicher Sehstörungen. Ca. eines von 3000 Kindern hat eine optisch signifikante Linsentrübung und bedarf einer Operation. Bis zum 2. Lebensjahr wird eine Lentektomie mit anschließender Kontaktlinsenversorgung und Bifokalbrille durchgeführt. Ab dem 2. Lebensjahr kann eine IOL implantiert werden. Dabei sind prophylaktische Maßnahmen gegen Nachstar notwendig. Die Operation sollte so früh erfolgen, dass keine Amblyopie resultiert. Eine zu früh terminierte Operation geht jedoch mit dem erhöhten Risiko eines Sekundärglaukoms einher. Daher wird bei angeborener Katarakt heute empfohlen, eine einseitige Katarakt bis zur 6. Lebenswoche, eine beidseitige bis zur 10. Lebenswoche zu operieren. Eine gut abgestimmte Zusammenarbeit von Ophthalmologen, Orthoptistinnen und Eltern ist Voraussetzung für gute funktionelle Ergebnisse. Diese Übersichtsarbeit befasst sich mit den wichtigsten Fragen zum Operationszeitpunkt, OP-Techniken, funktionellen Ergebnissen, Komplikationen sowie zur visuellen Rehabilitation.

Abstract

Congenital and juvenile cataracts are one of the leading causes of childhood blindness. About one out of 3000 children has or develops optically significant lens opacities that need surgery early in life. Up to the age of two years, the eyes remain aphacic and are corrected with contact lenses and bifocal glasses following surgery. Beyond the age of two years, IOL implanation is safe and sufficiently precise, but requires surgical measures to prevent secondary cataract. In congenital cases, surgery should be performed early enough to prevent amblyopia, but not too early in order to reduce the likelihood of secondary glaucoma. Hence, unilateral cataracts should be operated on in the sixth week of life, bilateral ones in the tenth week. Optimal interaction between surgeons, orthoptists and parents are prerequisites for good functional outcomes. This review covers the most important aspects of the timing of surgery, surgical techniques, visual outcomes, complications and postsurgical visual rehabilitation.

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Prof. Dr. med. Wolf A. Lagrèze

Universitäts-Augenklinik

79106 Freiburg

Email: mail@lagreze.de