Zusammenfassung
Gelegentlich kommt es trotz aller Sorgfalt und präziser Operationstechnik in der Katarakt-
und Refraktivchirurgie zu unbefriedigenden refraktiven und visuellen Ergebnissen.
In diesen Fällen ist eine nachträgliche Korrektur erforderlich, um das beste endgültige
visuelle Ergebnis zu erzielen. Dieser Beitrag zeigt die Möglichkeiten zur Behandlung
residualer Refraktionsfehler nach Linsen- und refraktiver Hornhautchirurgie auf.
Abstract
Background Modern preoperative diagnostics as well as current surgical techniques allow cataract
and refractive surgery to deliver precise refractive results.
Occasionally, unsatisfactory refractive and visual results occur despite all the care
taken. In these cases, subsequent improvement is required to achieve the best final
visual outcome. This article shows the therapeutic options for the treatment of residual
refractive errors after lens and corneal refractive surgery.
Key messages The causes of postoperative refractive errors after refractive laser- or lens-based
procedures are very diverse and require extensive workup of the cause as well as an
individual solution to achieve the desired result. Before any further surgical intervention,
specific complications of the primary procedure as well as concomitant ocular diseases
must be excluded or treated. The appropriate enhancement after keratorefractive surgery
depends primarily on the type of primary surgery, residual stromal thickness, possible
complications from the initial surgery, and the patientʼs personal preference. For
enhancements using surface treatments, such as PRK, the use of mitomycin C is recommended
for prophylaxis of haze formation. After lens surgery, for low-grade postoperative
refractive errors (spherical and astigmatic), keratorefractive enhancements provide
the most accurate results. For higher refractive errors, lens-based procedures can
be used, with add-on IOLs being safer and more precise compared with one IOL exchange.
Low astigmatisms can be successfully treated with LRI or keratorefractive surgery,
but higher astigmatisms should be corrected with an IOL exchange in the early postoperative
period and with an add-on IOL in the later postoperative period. IOL explantations
should be performed very cautiously, especially in cases of pronounced capsular fibrosis,
previous posterior capsulotomy, and existing weakness of the zonular apparatus.
Schlüsselwörter
Enhancement - Bioptics - refraktiver residualer Fehler - refraktive Überraschung -
Kataraktchirurgie
Key words
cornea-based enhancement - lens-based enhancement - refractive surprise - residual
refractive error - cataract surgery
