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Refractive Lens Surgery
Refractive Lens Exchange
The procedure of replacing the body's natural lens with a synthetic lens (lens exchange) has been used for the correction of cataract (age related opacity of the lens) since the 1960's. The procedure described here differs insofar as the lens of a younger person still is clear ("clear lens extraction") and he or she will loose the accommodation ability.
Synonyms:
RLE: refractive lens exchange, CLE: clear lens exchange
PRELEX: presbyopic lens exchange in a multifocal lens is implanted
Indication
— Farsightedness over +8 dpt.
— Nearsightedness exceeding -20 dpt.
A lens exchange for purely refractive purposes is therefore only indicated if the extreme near- or farsightedness is combined with either an age of at least 40 years or a beginning cataract (age-related opacity of the lens) is diagnosed. The loss of accommodation can be compensated with the implantation of a multifocal lens (PRELEX).
Properties
— rehabilitation within one week
— good predictability of the result
— non-reversibility of the procedure
— loss of accommodation (reading glasses become necessary unless multifocal lens is used)
— higher postoperative risk of retinal ablation
The procedure
The patient receives a custom made synthetic lens with life long durability. Prior to surgery, the strength (refractive power) of the new lens was calculated precisely based on ultrasonic measurements.
The surgery is generally done under local anesthesia. It lasts for up to 30 minutes and consists of two steps:
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First, the body's own lens is removed: the anterior lens capsule of the human lens is opened by a small 2.8 mm circular peripheral incision. |
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Through this small incision, the lens nucleus is emulsified with an ultrasonic needle (phacoemulsification) and the nucleus and lens are aspirated. |
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Now, the removed lens is replaced with a synthetic lens. With a special instrument, it is "injected" into the empty lens capsule through the small peripheral opening. It now replaces the natural lens. |
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By using techniques, where parts of the lens capsule (especially the posterior capsule) remain in the eye as a supporting structure, a fine opacity may occur at a later point. This can be corrected without anesthesia by using a YAG laser. Fortunately, complications only occur very infrequently if an experienced ophthalmologist does the surgery, and they can be controlled in most cases |
