Reoperationsrate nach Amnionmembrantransplantation

 

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Zusammenfassung

Hintergrund: Retrospektive Evaluierung der Reoperationsrate nach Amnionmembrantransplantation bei unterschiedlichen Krankheitsbildern. Material und Methoden: Eingeschlossen wurden insgesamt 81 Patienten, bei denen seit 1997 eine Amnionmembrantransplantation (AMT) an der Universitätsaugenklinik Tübingen durchgeführt wurde und bei denen eine Verlaufsbeobachtungszeit von mindestens 12 Monaten gewährleistet war. Die jeweils zugrunde liegenden Behandlungsdiagnosen wurde wie folgt gruppiert: Bindehautdefekt nach Tumorexzision (n = 2), bullöse Keratopathie (n = 5), externe Fistulation nach filtrierender Glaukomoperation (n = 3), Pterygiumrezidiv (n = 5) Symblepharon (n = 6), Ulcus corneae mit Descemetozele (n = 3), Ulcus corneae, nicht perforiert (n = 51), Ulcus corneae, perforiert (n = 1), sonstige (n = 5). Ergebnisse: Nach einem Jahr Verlaufsbeobachtungszeit lag die Reoperationsrate bei 41 %. Die häufigsten Reoperationen waren eine erneute AMT (n = 16) und eine perforierende Keratoplastik (n = 16). Nach Behandlungsdiagnosen unterteilt zeigte sich folgende Reoperationsrate: Bindehautdefekt nach Tumorexzision (0 %), bullöse Keratopathie (60 %), externe Fistulation nach filtrierender Glaukomoperation (67 %), Pterygiumrezidiv (60 %) Symblepharon (67 %), Ulcus corneae mit Descemetozele (67 %), Ulcus corneae, nicht perforiert (49 %), Ulcus corneae, perforiert (100 %). Schlussfolgerungen: Bei Patienten mit Bindehautdefekten nach Tumorexzisionen und mit nicht perforiertem Hornhautulkus sind die Chancen am größten, den Befund durch eine einmalige AMT für mindestens ein Jahr zu stabilisieren.

Abstract

Background: Retrospective evaluation of the frequency of reoperations after amniotic membrane transplantation for different pathologic entities. Material and Methods: We included 81 cases of amniotic membrane transplantation (AMT), which were operated on at the university eye clinic Tübingen since 1997 and which had been followed up for at least 12 months. Patient diagnoses were subdivided as follows: conjunctival defects after tumour excision (N = 2), bullous keratopathy (N = 5), external fistula after glaucoma filtering surgery (N = 3), recurrent pterygium (N = 5), symblepharon (N = 6), corneal ulcer with descemetocele (N = 3), non-perforated corneal ulcer (N = 51), perforated corneal ulcer (N = 1), other (n = 5). Results: The overall reoperation rate was determined to be 42 % after a follow-up period of one year. Most frequently, a second AMT (N = 16) and a perforating keratoplasty (N = 16) were performed after the initial AMT. The following reoperation rates were determined for the subgroups: Conjunctival defects after tumour excision (0 %), Bullous keratopathy (60 %), External fistula after glaucoma filtering surgery (67 %), Recurrent pterygium (60 %), Symblepharon (67 %), Corneal ulcer with descemetocele (67 %), Non-perforated corneal ulcer (49 %), Perforated corneal ulcer (100 %). Conclusions: Particularly in patients with conjunctival defects after tumour excision and with non-perforated corneal ulcers, stabilisation of the ocular surface homeostasis can be achieved with a single amniotic membrane transplantation for at least one year.

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PD Dr. med. Oliver Peter Denk

Universitätsaugenklinik

Schleichstraße 12

72076 Tübingen

Email: podenk@med.uni-tuebingen.de