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Das chirurgische Verfahren zur Behandlung des Pterygiums mit einem autologen Konjunktiva-Limbus-Transplantat – Ergebnis einer retrospektiven klinischen Studie

Treatment of pterygium with free conjunctival limbal autograft—outcome of a retrospective clinical study

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Zusammenfassung

Hintergrund

Ziel dieser retrospektiven Studie war es, Effektivität, Sicherheit sowie Häufigkeit und Ausdehnung der Rezidivrate nach chirurgischer Behandlung des Pterygiums mittels autologen Konjunktiva-Limbus-Transplantat zu untersuchen.

Material und Methode

Als chirurgisches Verfahren wurde im Zeitraum von Jänner 2001 bis März 2007 bei 116 Augen von 112 Patienten die Exzision des Pterygiums mit nachfolgender Deckung mittels autologen Konjunktiva-Limbus-Transplantat bei primären und rezidivierenden Pterygien angewendet.

Es wurden Veränderungen des kornealen Astigmatismus gemessen und die Verbesserung des bestkorrigierten Visus bestimmt. Zur Feststellung eines Rezidivs wurden postoperative Bilder bei der Kontrolluntersuchung angefertigt und das Ergebnis durch Einteilung in Zonen klassifiziert. Mittels Fragebogen konnten die postoperativen Beschwerden der Patienten erhoben werden.

Ergebnisse

64 Augen von 62 Patienten wurden in diese Studie inkludiert. Die postoperative Nachbeobachtungszeit reichte von 4 bis 78,5 Monaten. Rezidive konnte man bei 2 von 64 Augen (3,1 %) feststellen, eines (2 %) von 51 präoperativ primären Pterygien und eines (7,7 %) von 13 rezidivierenden Pterygien. Korneale Narben konnte man bei 18 (28,1 %) von 64 Pterygien nachweisen, davon reichten bei 14 Fällen (21,9 %) die Narben nicht über den Limbus und bei den restlichen 4 Fällen (6,3 %) nicht über 2,5 mm auf die Kornea, waren flach und nicht erhaben. Der korneale Astigmatismus konnte von 1,6 dpt präoperativ auf 1 dpt postoperativ signifikant verringert werden (p < 0,001).

Schlussfolgerung

Das autologe Konjunktiva-Limbus-Transplantat erweist sich als sicheres und effektives chirurgisches Behandlungsverfahren zur Therapie primärer und rezidivierender Pterygien. Außerdem scheint das Verfahren essentiell zu sein, um eine niedrige Rezidivrate über einen langen Zeitraum zu erzielen.

Summary

Background

Aim of this study was to describe efficiency, safety, frequency and extent of the recurrence rate using the temporal free conjunctivo-limbal autograft transplantation technique in the surgical management of pterygium in a retrospective analysis.

Material and methods

One hundred sixteen eyes of 112 patients with primary and recurrent pterygium were surgically treated by the technique of excision and covering with free conjunktivo-limbal autograft between January 2001 and March 2007.

During the follow-up examination the best corrected visual acuity, astigmatism changes and slit lamp findings were noted. Recurrence rate was determined by comparison of postoperative pictures. On the basis of a questionnaire data including preoperative visual acuity and astigmatism, postoperative discomfort were collected.

Results

Sixty four eyes of 62 patients were included in our study. The postoperative follow up ranged from 4 to 78.5 months. Recurrence of pterygium occured in 2 out of 64 eyes (3.1 %). One (2 %) of 51 was preoperatively a primary pterygium and one (7.7 %) of 13 was preoperatively a recurrent pterygium. Corneal scars were assessed in 18 (28.1 %) of 64, thereof in 14 cases (21.9 %) the scars did not cross limbus whereas in 4 cases (6.3 %) the scars crossed limbus were plain but did not pass 2.5 mm of cornea. Corneal astigmatism was significantly reduced from 1.6 to 1.0 dpt (p < 0.001).

Conclusions

Free conjunctivo-limbal autograft is a safe and effective surgical treatment of primary and recurrent pterygia and it appears to be essential to ensure low recurrence rate at long follow-up.

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Authors and Affiliations

  1. Universitätsklinik für Augenheilkunde und Optometrie der Paracelsus Medizinischen Privatuniversität Salzburg, Salzburger Landeskliniken – Landeskrankenhaus, Müllner Hauptstraße 48, 5020, Salzburg, Österreich

    Martin Emesz

  2. Univ.-Augenklinik der PMU Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Österreich

    Nicole Pettke, Wolfgang Hitzl, Alois Karl Dexl, Christian Nischler, Günther Grabner & Eva Krall

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Emesz, M., Pettke, N., Hitzl, W. et al. Das chirurgische Verfahren zur Behandlung des Pterygiums mit einem autologen Konjunktiva-Limbus-Transplantat – Ergebnis einer retrospektiven klinischen Studie. Spektrum Augenheilkd. 27, 131–137 (2013). https://doi.org/10.1007/s00717-013-0156-7

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