Zuverlässiger UV-Schutz durch Intraokularlinsen – Rationale und Qualitätsanforderungen

 

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Zusammenfassung

Seit etwa Ende der 80er-Jahre des letzten Jahrhunderts gilt die Implantation von UV-Blockerlinsen nach Kataraktextraktion als international anerkannter therapeutischer Standard. Im letzten Jahr haben die Kassenärztliche Vereinigung Bayern (KVB) und die gesetzlichen Krankenkassen erstmals gemeinsam Qualitätskriterien für Intraokularlinsen vorgeschlagen, in denen auch eine maximal zulässige UV-Transmission von 10 % bis 400 nm festgelegt ist. Seither wird erneut diskutiert, in welchem Umfang Intraokularlinsen (IOL) das UV-Licht filtern sollten. Im vorliegenden Artikel werden zunächst exakte Definitionen der Spektralbereiche des Lichtes aufgeführt. So gilt die Grenze von 400 nm heute als anerkannter Standard zur Abgrenzung von UV-Licht und sichtbarem Licht. Weiterhin wird der Umfang der Strahlenbelastung des Auges durch UV-Licht ebenso erläutert wie Mechanismen oxidativer Schädigung der Retina durch UV-Licht. Umfassende labor- und tierexperimentelle Untersuchungen belegen, dass kurzwelliges Licht, d. h. v. a. UV-Licht, aber auch blaues Licht, photochemische Schäden an der Netzhaut verursachen kann, wobei die primären Orte der Schädigung die Außensegmente der Photorezeptoren und das retinale Pigmentepithel (RPE) sind. Physiologische Schutzmechanismen des Auges vor UV-Licht wie u. a. die Filtereigenschaften okulärer Strukturen werden detailliert beschrieben. So wird die UV-Strahlung bis 300 nm durch Hornhaut, Kammerwasser und Glaskörper gefiltert, während die UV-Strahlung von 300–400 nm durch die natürliche, klare Linse eines Erwachsenen weitgehend gefiltert wird. Im Rahmen der Kataraktchirurgie wird die natürliche Linse und damit der Schutz der Retina vor UV-Licht von 300–400 nm entfernt. Da UV-Licht nicht zum Sehvermögen beiträgt, aber retinale Strukturen schädigen kann, sollte daher im Rahmen der Kataraktoperation eine UV-Blocker-Intraokularlinse implantiert werden, die bis nahe 400 nm über eine maximale Durchlässigkeit von 10 % oder sogar weniger verfügt, um so auch nach Kataraktoperation einen UV-Schutz der Netzhaut zu gewährleisten. Diese theoretischen Erwägungen werden durch zahlreiche experimentelle und klinische Belege untermauert.

Abstract

Since the late 1980s implantation of UV-blocker intraocular lenses during cataract surgery has become an internationally accepted standard. Last year the Kassenärztliche Vereinigung Bayern (KVB) and statutory health insurance organisations proposed for the first time quality criteria for intraocular lenses (IOL), thereby including exact parameters for the amount of UV light transmission (≤ 10 % at 400 nm). Since then, the discussion has been raised again as to what extent IOLs should filter or block UV light. In this article, exact definitions of spectral subbands within the optical radiation band are given. Today, 400 nm is the internationally accepted standard to distinguish UV light and visible light. Moreover, exposure of the eye to UV radiation is described as well as mechanisms of photooxidative damage to the retina. Comprehensive laboratory and animal experimental studies show that light of short wave lengths, i.e., above all UV light but also blue light, may induce photochemical damage to the retina. Primary sites of such damage are both the outer segments of the photoreceptors and the retinal pigment epithelium (RPE). Physiological protective mechanisms of the eye, such as filtering properties of different ocular media are described in detail. Cornea, aqueous and vitreous absorb UV radiation below 300 nm, while the natural adult lens absorbs UV radiation between 300 and 400 nm. This protection is lost when the lens is removed by cataract surgery and thus should be restored. UV light does not contribute to vision but damages retinal structures. Therefore, UV-blocking intraocular lenses with a 10 % cut-off near 400 nm should be implanted during cataract surgery. This ensures sufficient retinal protection after surgery. These theoretical considerations are supported by results from animal and clinical studies.

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