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Operative Techniken bei chirurgischer Behandlung primärer und rezidivierender Pterygien

Operative techniques for surgical treatment of primary and recurrent pterygia

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Zusammenfassung

Da es sich bei einem Pterygium um einen gutartigen Tumor handelt [20], stellt sich v. a. bei einem zunehmenden Wachstum die Frage der Resektion. Seltenere Indikationen sind kosmetische Probleme und eine Minderbenetzung der Augenoberfläche. Die hierzulande am häufigsten angewandte Operationsmethode ist die Pterygiumresektion mit einem freien Bindehauttransplantat, wobei je nach Präferenz des Operateurs eine adjuvante Antimetabolitentherapie entweder bereits bei primären Resektionen oder erst bei Rezidiven eingesetzt wird. Alternativ bietet sich eine Defektdeckung mittels Schwenklappen an. Bei Rezidiven ist eine kombinierte Bindehaut-Limbusstammzelltransplantation zu diskutieren. Wenn kein gesundes autologes Bindehautmaterial für die Defektdeckung zur Verfügung steht, kann man auf eine Amnionmembrandeckung zurückgreifen. Bei tieferen Hornhautdefekten kommt eine lamelläre Sektorkeratoplastik in Frage. Die bisherige Praxis der Transplantatverankerung mittels Fadenmaterial scheint in ihrer Häufigkeit zugunsten der Fibrinklebung abzun ehmen.

Abstract

Surgical treatment of pterygia is indicated when there is a reduction of visual acuity secondary to the development of irregular astigmatism and an (impending) obscuration of the visual axis by the tumor. Poor cosmetic appearance and an insufficient corneal lubrication are more rare indications. The most popular surgical technique in this country appears to be a free conjunctival autograft which, depending on the priority of the surgeon, is combined with adjunctive antimetabolite therapy applied either in primary or recurrent cases. A simultaneous transplantation of conjunctival and limbal stem cell autografts is an excellent method to be considered particularly in cases of recurrent pterygia. In the case of non-existing healthy autologous tissue the resection bed can be covered by preserved amniotic membrane. A lamellar sectorial corneal graft might become necessary if there is a deep corneal defect. The well established technique of suturing the graft has been replaced by fibrin glue in some surgical centers.

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Danksagung

Die intraoperativen Fotoaufnahmen wurden von Roland Schmidt, medizinischer Fotograph, Uni Marburg, gemacht.

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

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Authors and Affiliations

  1. Augenklinik der Universität Gießen und Marburg GmbH, Standort Marburg und Philipps-Universität Marburg, Robert-Koch-Straße 4, 35037, Marburg, Deutschland

    W. Sekundo & K. Droutsas

  2. Augenklinik mit Poliklinik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen-Nürnberg, Deutschland

    C. Cursiefen

  3. Netherlands Institute for Innovative Ocular Surgery, Rotterdam, Niederlande

    K. Droutsas

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  1. W. Sekundo
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  2. K. Droutsas
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  3. C. Cursiefen
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Correspondence to W. Sekundo.

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Sekundo, W., Droutsas, K. & Cursiefen, C. Operative Techniken bei chirurgischer Behandlung primärer und rezidivierender Pterygien. Ophthalmologe 107, 525–528 (2010). https://doi.org/10.1007/s00347-009-2099-6

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  • DOI: https://doi.org/10.1007/s00347-009-2099-6

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