Feldhaus Lukas, Luft Nikolaus, Mayer Wolfgang
Klin Monbl Augenheilkd. 2023 Mar;240(3):332-350. doi: 10.1055/a-2022-0993. Epub 2023 Feb 24.
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.
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 patient's 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.
现代术前诊断以及当前的手术技术使白内障和屈光手术能够实现精确的屈光效果。尽管已采取了所有护理措施，但偶尔仍会出现不尽人意的屈光和视觉效果。在这些情况下，需要后续改善以实现最佳的最终视觉结果。本文展示了晶状体和角膜屈光手术后残余屈光不正的治疗选择。
屈光性激光手术或晶状体手术术后屈光不正的原因非常多样，需要对病因进行全面检查并采取个体化解决方案以达到预期效果。在进行任何进一步的手术干预之前，必须排除或治疗初次手术的特定并发症以及伴随的眼部疾病。角膜屈光手术后合适的增效手术主要取决于初次手术的类型、残余基质厚度、初次手术可能出现的并发症以及患者的个人偏好。对于使用表面治疗（如PRK）的增效手术，建议使用丝裂霉素C预防 haze 形成。晶状体手术后，对于低度术后屈光不正（球镜和散光），角膜屈光增效手术能提供最精确的结果。对于较高的屈光不正，可以采用基于晶状体的手术，与单次人工晶状体置换相比，附加型人工晶状体更安全、更精确。低度散光可通过激光视网膜切开术（LRI）或角膜屈光手术成功治疗，但高度散光应在术后早期通过人工晶状体置换进行矫正，在术后后期通过附加型人工晶状体进行矫正。人工晶状体取出术应非常谨慎地进行，尤其是在存在明显的囊膜纤维化、既往后囊切开术以及悬韧带装置存在薄弱的情况下。
