Eintrübung von Intraokularlinsen

Zusammenfassung

Das Spektrum an Komplikationen und die Explantationsgründe bei der Verwendung von Intraokularlinsen (IOL) haben sich durch die Weiterentwicklung der Kataraktchirurgie verändert. Eintrübungen des Materials beeinflussen dabei unterschiedlich stark die optische Qualität. Im Fall einer störenden Eintrübung des Materials ist auch heute noch – trotz aller Fortschritte auf dem Gebiet der IOL-Materialien – ein Austausch der IOL die einzige Behandlungsoption.

Abstract

The spectrum of complications in the use of intraocular lenses (IOL) is different today from at the time of their introduction. Opacities in the IOL material are increasingly described in the literature as a reason for IOL explantation. This paper provides an overview of the different forms of IOL material opacities. Currently relevant forms of IOL material opacities and their effects on optical quality are summarized. The main reason for opacification in hydrophilic IOLs is calcification, whereas in hydrophobic IOLs it is mainly the formation of so-called glistenings that is reported. Most material opacities affect various optical parameters and lead to increased intraocular straylight. In case of a disturbing material opacification, the only therapeutic option is to replace the opacified IOL.

Kernaussagen

• Während als Materialveränderung bei hydrophoben IOL v. a. über sogenannte „Glistenings“ berichtet wird, steht bei hydrophilen IOL die Kalzifikation im Vordergrund.

• Art und Schweregrad der Pathologie hängen vom Linsenmaterial, dem Linsenherstellungsprozess und den örtlichen Umgebungsbedingungen ab.

• In der klinischen Praxis ist besonders auf die exakte Lage der Eintrübung zu achten (vor, innerhalb oder hinter der IOL), damit Differenzialdiagnosen ausgeschlossen werden und der Patient die korrekte Behandlung erhält.

• Bei entsprechenden Behandlungsentscheidungen sollten die Unterschiede bezüglich der Funktionsstörung, die durch die verschiedenen Formen der Materialveränderungen erzeugt werden, berücksichtigt werden.

• Liegt eine beeinträchtigende Materialveränderung vor, so muss als derzeit einzige sinnvolle therapeutische Option der IOL-Tausch besprochen werden, der allerdings mit entsprechenden Risiken einhergeht.

Schlüsselwörter

IOL - hydrophob - hydrophil - Kunstlinse

Key words

hydrophilic - hydrophobic - complication - IOL - straylight

Publication History

Article published online:
19 April 2021

• Literatur

• 1 Kanclerz P, Yildirim TM, Khoramnia R. A review of late intraocular lens opacifications. Curr Opin Ophthalmol 2021; 32: 31-44 doi:10.1097/ICU.0000000000000719
• 2 Khoramnia R, Yildirim TM, Labuz G. et al. Eintrübung von Intraokularlinsen: Erkenntnisse aus dem Labor und der Klinik. Ophthalmologe 2020; DOI: 10.1007/s00347-020-01259-3.
• 3 Kanclerz P, Yildirim TM, Khoramnia R. Microscopic characteristics of late intraocular lens opacifications. Arch Pathol Lab Med 2020; DOI: 10.5858/arpa.2019-0626-RA.
• 4 Son HS, Khoramnia R, Yildirim TM. et al. Functional outcomes and reading performance after combined implantation of a small-aperture lens and a segmental refractive bifocal lens. J Refract Surg 2019; 35: 551-558 doi:10.3928/1081597X-20190806-02
• 5 Yildirim TM, Auffarth GU, Son HS. et al. Bilateral trifocal IOL implantation in a pediatric case of cataract following steroid-therapy for acute lymphoblastic leukemia. Am J Ophthalmol Case Rep 2018; 13: 46-49 doi:10.1016/j.ajoc.2018.11.014
• 6 Neuhann T, Yildirim TM, Son HS. et al. Reasons for explantation, demographics, and material analysis of 200 intraocular lens explants. J Cataract Refract Surg 2020; 46: 20-26 doi:10.1016/j.jcrs.2019.08.045
• 7 Apple DJ, Peng Q, Arthur SN. et al. Snowflake degeneration of polymethyl methacrylate posterior chamber intraocular lens optic material: a newly described clinical condition caused by unexpected late opacification of polymethyl methacrylate. Ophthalmology 2002; 109: 1666-1675 doi:10.1016/s0161-6420(02)01122-3
• 8 Stanojcic N, Hull C, OʼBrart DP. Clinical and material degradations of intraocular lenses: A review. Eur J Ophthalmol 2020; 30 (05) 823-839 doi:10.1177/1120672119867818
• 9 Espandar L, Mukherjee N, Werner L. et al. Diagnosis and management of opacified silicone intraocular lenses in patients with asteroid hyalosis. J Cataract Refract Surg 2015; 41: 222-225 doi:10.1016/j.jcrs.2014.11.009
• 10 Dhaliwal DK, Mamalis N, Olson RJ. et al. Visual significance of glistenings seen in the AcrySof intraocular lens. J Cataract Refract Surg 1996; 22: 452-457
• 11 Dick HB, Olson RJ, Augustin AJ. et al. Vacuoles in the Acrys of intraocular lens as factor of the presence of serum in aqueous humor. Ophthalmic Res 2001; 33: 61-67 doi:10.1159/000055645
• 12 Wang Q, Yildirim TM, Schickhardt SK. et al. Quantification of the in vitro predisposition to glistening formation in one manufacturerʼs acrylic intraocular lenses made in different decades. Ophthalmol Ther 2021; 10: 165-174 doi:10.1007/s40123-020-00329-8
• 13 Werner L. Glistenings and surface light scattering in intraocular lenses. J Cataract Refract Surg 2010; 36: 1398-1420 doi:10.1016/j.jcrs.2010.06.003
• 14 Oshika T, Fujita Y, Inamura M. et al. Mid- and long-term clinical assessment of a new single-piece hydrophobic acrylic intraocular lens with hydroxyethyl-methacrylate. J Cataract Refract Surg 2020; DOI: 10.1097/j.jcrs.0000000000000142.
• 15 Yildirim TM, Fang H, Schickhardt SK. et al. Glistening formation in a new hydrophobic acrylic intraocular lens. BMC Ophthalmol 2020; 20: 186 doi:10.1186/s12886-020-01430-z
• 16 Tandogan T, Auffarth GU, Son HS. et al. In-vitro glistening formation in six different foldable hydrophobic intraocular lenses. BMC Ophthalmol 2021; 21: 126 doi:10.1186/s12886-021-01879-6
• 17 Baur ID, Auffarth GU, Labuz G. et al. Unilaterale Implantation einer neuen Intraokularlinse mit erweiterter Tiefenschärfe bei einem jungen Patienten. Ophthalmologe 2020; DOI: 10.1007/s00347-020-01285-1.
• 18 Neuhann IM, Kleinmann G, Apple DJ. A new classification of calcification of intraocular lenses. Ophthalmology 2008; 115: 73-79 doi:10.1016/j.ophtha.2007.02.016
• 19 Tandogan T, Khoramnia R, Choi CY. et al. Optical and material analysis of opacified hydrophilic intraocular lenses after explantation: a laboratory study. BMC Ophthalmol 2015; 15: 170 doi:10.1186/s12886-015-0149-1
• 20 Khoramnia R, Salgado JP, Auffarth GU. et al. Eintrübung einer hydrophilen Intraokularlinse 4 Jahre nach Kataraktoperation. Ophthalmologe 2012; 109: 483-486 doi:10.1007/s00347-011-2487-6
• 21 Yildirim TM, Labuz G, Khoramnia R. et al. Impact of primary calcification in segmented refractive bifocal intraocular lenses on optical performance including straylight. J Refract Surg 2020; 36: 20-27 doi:10.3928/1081597X-20191119-01
• 22 Frohn A, Dick HB, Augustin AJ. et al. Late opacification of the foldable hydrophilic acrylic lens SC60B-OUV. Ophthalmology 2001; 108: 1999-2004
• 23 Tehrani M, Mamalis N, Wallin T. et al. Late postoperative opacification of MemoryLens hydrophilic acrylic intraocular lenses: case series and review. J Cataract Refract Surg 2004; 30: 115-122 doi:10.1016/S0886-3350(03)00461-9
• 24 Izak AM, Werner L, Pandey SK. et al. Calcification of modern foldable hydrogel intraocular lens designs. Eye (London) 2003; 17: 393-406 doi:10.1038/sj.eye.6700341
• 25 Gurabardhi M, Haberle H, Aurich H. et al. Serial intraocular lens opacifications of different designs from the same manufacturer: Clinical and light microscopic results of 71 explant cases. J Cataract Refract Surg 2018; 44: 1326-1332 doi:10.1016/j.jcrs.2018.07.026
• 26 Scherer NCD, Muller K, Prahs PM. et al. Serial opacification of a hydrophilic-hydrophobic acrylic intraocular lens – analysis of potential risk factors. J Cataract Refract Surg 2020; DOI: 10.1097/j.jcrs.0000000000000342.
• 27 Khoramnia R, Auffarth GU, Rabsilber TM. et al. Implantation of a multifocal toric intraocular lens with a surface-embedded near segment after repeated LASIK treatments. J Cataract Refract Surg 2012; 38: 2049-2052 doi:10.1016/j.jcrs.2012.08.042
• 28 Nakanome S, Watanabe H, Tanaka K. et al. Calcification of Hydroview H60 M intraocular lenses: aqueous humor analysis and comparisons with other intraocular lens materials. J Cataract Refract Surg 2008; 34: 80-86 doi:10.1016/j.jcrs.2007.08.020
• 29 Agresta A, Giudiceandrea A, Salgarello T. et al. Influence of aqueous humor convection current on IOL opacification. Int Ophthalmol 2017; 37: 1337-1339 doi:10.1007/s10792-016-0400-7
• 30 Marcovich AL, Tandogan T, Bareket M. et al. Opacification of hydrophilic intraocular lenses associated with vitrectomy and injection of intraocular gas. BMJ Open Ophthalmol 2018; 3: e000157 doi:10.1136/bmjophth-2018-000157
• 31 Roland S, Khoramnia R, Auffarth GU. et al. Eintrübung einer hydrophilen Intraokularlinse nach multiplen Bevacizumab-Injektionen. Ophthalmologe 2019; 116: 882-886 doi:10.1007/s00347-018-0829-3
• 32 Yildirim TM, Auffarth GU, Labuz G. et al. Material analysis and optical quality assessment of opacified hydrophilic acrylic intraocular lenses after pars plana vitrectomy. Am J Ophthalmol 2018; 193: 10-19 doi:10.1016/j.ajo.2018.06.002
• 33 Fung SS, Sykakis E, Islam NM. et al. intraocular lens opacification following intracameral injection of recombinant tissue plasminogen activator to treat inflammatory membranes after cataract surgery. J Ophthalmol 2015; 2015: 975075 doi:10.1155/2015/975075
• 34 Schrittenlocher S, Penier M, Schaub F. et al. intraocular lens calcifications after (triple-) descemet membrane endothelial keratoplasty. Am J Ophthalmol 2017; 179: 129-136 doi:10.1016/j.ajo.2017.04.024
• 35 Ahad MA, Darcy K, Cook SD. et al. Intraocular lens opacification after descemet stripping automated endothelial keratoplasty. Cornea 2014; 33: 1307-1311
• 36 Milojcic C, Latz C, Tandogan T. et al. Eintrübung einer hydrophilen Acryl-Intraokularlinse nach DMEK. Ophthalmologe 2017; 114: 832-837 doi:10.1007/s00347-016-0394-6
• 37 Yildirim TM, Khoramnia R, Schickhardt SK. et al. Variation in intraocular lens calcification under different environmental conditions in eyes with supplementary sulcus-supported lenses. Am J Ophthalmol Case Rep 2020; DOI: 10.1016/j.ajoc.2020.100797.
• 38 Giers BC, Tandogan T, Auffarth GU. et al. Hydrophilic intraocular lens opacification after posterior lamellar keratoplasty – a material analysis with special reference to optical quality assessment. BMC Ophthalmol 2017; 17: 150 doi:10.1186/s12886-017-0546-8
• 39 Giers BC, Khoramnia R, Tandogan T. et al. Flüssiger Nachstar imitiert IOL-Trübung. Klin Monbl Augenheilkd 2017; 234: 988-990 doi:10.1055/s-0042-121808
• 40 Weindler JN, Labuz G, Yildirim TM. et al. The impact of glistenings on the optical quality of a hydrophobic acrylic intraocular lens. J Cataract Refract Surg 2019; 45: 1020-1025 doi:10.1016/j.jcrs.2019.01.025
• 41 Labuz G, Knebel D, Auffarth GU. et al. Glistening formation and light scattering in six hydrophobic-acrylic intraocular lenses. Am J Ophthalmol 2018; 196: 112-120 doi:10.1016/j.ajo.2018.08.032
• 42 Labuz G, Yildirim TM, van den Berg T. et al. Assessment of straylight and the modulation transfer function of intraocular lenses with centrally localized opacification associated with the intraocular injection of gas. J Cataract Refract Surg 2018; 44: 615-622 doi:10.1016/j.jcrs.2018.01.033
• 43 Yildirim TM, Labuz G, Hammer M. et al. A novel approach for assessing visual impairment caused by intraocular lens opacification: high-resolution optical coherence tomography: Straylight prediction in locally opacified IOLs. Am J Ophthalmol 2021; 226: 108-116 doi:10.1016/j.ajo.2021.02.001
• 44 Labuz G, Yildirim TM, Khoramnia R. et al. The comparison of the intraocular lensʼ optical function in different opacification patterns: a metrology analysis of 67 explants. J Cataract Refract Surg 2020; DOI: 10.1097/j.jcrs.0000000000000553.
• 45 Dagres E, Khan MA, Kyle GM. et al. Perioperative complications of intraocular lens exchange in patients with opacified Aqua-Sense lenses. J Cataract Refract Surg 2004; 30: 2569-2573 doi:10.1016/j.jcrs.2004.04.055
• 46 Leysen I, Bartholomeeusen E, Coeckelbergh T. et al. Surgical outcomes of intraocular lens exchange: five-year study. J Cataract Refract Surg 2009; 35: 1013-1018 doi:10.1016/j.jcrs.2009.01.024
• 47 Dick B, Auffarth G. Eintrübung von Intraokularlinsen. Ophthalmochirurgie 2018; 30: 13-17