E-PTFE Membran für die Behandlung von perforiertem Hornhautulkus

 

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Zusammenfassung

Hintergrund: Die operative Behandlung von perforiertem Hornhautulkus mit der Verwendung von PRECLUDE® Pericardial Membrane, die aus expandiertem Polytetrafluorethylen besteht, als einen alternativen chirurgischen Eingriff bei Hochrisikopatienten für Abstoßreaktionen vorzustellen und die Nebenwirkungen über einen längeren Zeitraum zu bewerten.

Patienten und Methoden: In die Studie wurden alle Patienten eingeschlossen, die auf unserer Abteilung im Zeitraum zwischen 2010 und 2015 hospitalisiert wurden und einer chirurgischen Reparatur mit der Membran aus e-PTFE wegen eines perforierten Hornhautulkus unterzogen wurden. Schließlich wurden 8 Patienten (8 Augen) in die Studie eingeschlossen. Krankenberichte von allen Patienten wurden retrospektiv überprüft. Der Eingriff wurde unter peribulbärer Anästhesie vorgenommen. Für die Hornhautulkusdeckung wurde eine nicht resorbierbare, mikroporöse, wasserdichte und 0,1 mm dicke Membran aus e-PTFE verwendet. Ein passendes Membranteil wurde ausgeschnitten, um den Defekt entsprechend zu überdecken und die erwünschte Gewebeanhaftung zu erzielen ohne Bindehautvorbereitung oder oberflächliche Trepanation der Hornhaut. Die Membran wurde mit zahlreichen nicht resorbierbaren Fäden (Prolene® 10.0) auf dre gesunden Hornhaut befestigt, um eine angemessene Spannung ohne Faltenbildung zu erzielen.

Ergebnisse: Fünf von 8 Patienten wurden wegen systemischen Immunkrankheiten behandelt. Bei 2 Patienten wurde das perforierte Hornhautulkus als eine Komplikation nach Hornhautinfektion und bei 1 Patienten als eine späte Komplikation durch schwere Verätzung beobachtet. Alle Hornhautperforationen wurden erfolgreich mit der Membran aus e-PTFE abgedeckt. Bei allen Fällen konnte das Auge des Patienten erhalten werden. Bei 7 Fällen wurde die Membran nach 3 bis 4 Monaten entfernt. Die darunter liegende Hornhaut war dünn, fest, stabil und vaskularisiert.

Schlussfolgerung: Chirurgische Behandlung von perforiertem Hornhautulkus mit der Membran aus e-PTFE könnte die Methode der Wahl zur Erhaltung des Auges oder bei einer aufgeschobenen Hornhauttransplantation sein. Unsere Resultate bestätigten die Sicherheit und Wirksamkeit des Eingriffs; insbesondere bei Hochrisikopatienten. Nachdem die Membran entfernt ist, können alle Augen mit erwarteter Prognose für eine Verbesserung der Sehschärfe einer penetrierenden Keratoplastik (als definitive Therapie) unterzogen werden.

Abstract

Purpose: To present the surgical management of perforated corneal ulcer using PRECLUDE® Pericardial Membrane, composed of expanded polytetrafluoroethylene (e-PTFE; GORE-TEX®), as an alternative surgical procedure in patients at high risk of graft rejections and to evaluate side effects for a prolonged period.

Patients and Methods: The study included all patients who were admitted to our department and underwent surgical repair of perforated corneal ulcer with the e-PTFE membrane between 2010 and 2015. In total, 8 patients (8 eyes) were enrolled. Medical records of all patients were retrospectively reviewed. The operation was performed under peribulbar anaesthesia. Non-absorbable, microporous, watertight 0.1 mm thick e-PTFE membrane was used to close the corneal ulcer. The membrane was cut to overlap the defect adequately and to achieve the desired tissue attachment without preparing the conjunctiva or superficial trephination of the cornea. The membrane was fixed to the healthy cornea with several non-absorbable sutures (Prolene® 10.0), in order to achieve the proper stress without wrinkling.

Results: Five of 8 patients were treated for systemic immunological diseases. Sjögrenʼs syndrome was diagnosed in 2 patients, granulomatosis with polyangiitis in one, vasculitis with a history of previous sclerokeratitis in one and systemic lupus erythematosus in one. In 2 patients, corneal perforation was observed as a complication of corneal infection and in one patient as a late complication of a severe chemical burn. Corneal perforations were successfully covered with e-PTFE membrane in all patients. E-PTFE membrane was well tolerated in all patients and the eye was always preserved. After 3 to 4 months, the membrane was removed in 7 patients. The underlying cornea was thin, firm, stable and vascularised. In one patient with Sjögrenʼs syndrome, the e-PTFE membrane is still in place.

Conclusion: Surgical management of perforated corneal ulcer using E-PTFE membrane may be the method of choice for eye preservation or for delayed corneal transplantation. Our results confirmed that the procedure is safe and effective, especially in high risk patients. After removing the membrane, penetrating keratoplasty can be performed as a definitive treatment in all eyes where an improvement in visual acuity is expected.

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