Primäre (Duett Implantation) und sekundäre Implantation additiver Intraokularlinsen bei kindlicher Katarakt

Abstract

Background: Preliminary results with polypseudophakia in children are presented. Requirements on a sulcus supported supplementary IOL are defined. Surgical technique is described and indication for Duett-Implantation in children is analysed. Setting: Department of Ophthalmology, Academic Teaching Hospital of St John of God, Vienna, Austria Material and Methods: The (Sulcoflex ® ) IOL is designed for implantation into the ciliary sulcus in pseudophakic eyes ("piggy back"). It is a single-piece implant made of hydrophilic acrylic. Optic-and haptic-edges are round. The optic has a diameter of 6.5 mm and a concave/convex shape for perfect fit on the anterior convex surface of the primary IOL. The haptic is angulated, and has an undulated design to preclude IOL rotation. The same surgeon (M.A) performed all Sulcoflex ® implantations through a clear corneal incision (2.75 mm) under general anesthesia using a standardized technique. After surgery slitlamp examination, photodocumentation and visual function were assessed. Position of the IOL was documented regularly at all control visits. Results: In this prospective study 4 eyes of 4 patients received a monofocal Sulcoflex ® IOL with a primary IOL in the capsular bag. All surgeries were uneventful. Postoperative emmetropia (± 0.25 D) was achieved in all cases with stable refractions through the follow up period. In 2 cases fibrin was seen in the pupillary area during the first days after surgery. A few foreign body giant cells on the anterior IOL-surface were found in all cases, but they resolved after a few weeks. Occlusion therapy was possible in all patients. At the last visit all eyes were without inflammation and the two IOLs were well accepted.Conclusions: The Sulcoflex ® IOL is well tolerated within the eye. The implant can be used at the same time with the primary implant or at a later time as secondary implant.Additive IOL-Implantation helps optimizing the refractive results in children after cataract surgery.Zusammenfassung: Background: Die vorläufigen Ergebnisse mit Polypseudophakie (Sulcoflex ® ) bei kindlichen Patienten werden präsentiert. Es werden alle Erfordernisse an eine kammerwinkelgetragene Intraokularlinse (IOL) definiert. Die chirurgische Technik sowie die Indikation für eine Duett Implantation bei kindlicher Katarakt werden beschrieben. Material und Methode: Die Sulcoflex ® IOL ist für die Implantation in den Sulcus iridociliaris in pseudophaken Augen entwickelt worden. Es handelt sich um eine one-piece IOL aus hydrophilem Acryl deren Optik-und Haptikkanten abgerundet sind. Der Optikdurchmesser beträgt 6,5 mm und hat eine konkav/konvexe Form um einen guten Sitz und Distanz auf der konkaven Vorderfläche der kapselsackfixierten IOL zu sichern. Die Haptiken sind 10 Grad vorne anguliert und haben undulierte Ränder um Rotationen der IOL zu vermeiden.Ein Operateur (M. A.) führte alle Duett Implantationene über eine 2,75 mm clear corneal incision (CCI) unter Allgemeinanästhesie in Standardtechnik durch. Postoperativ wurden Spaltlampenuntersuchung mit Übe...