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Klin Monbl Augenheilkd 2004; 221(3): 197-203
DOI: 10.1055/s-2004-812913
Klinische Studie

© Karl Demeter Verlag im Georg Thieme Verlag Stuttgart · New York

Intraokulare Epithelimplantation - Bericht über 14 Patienten 1986 - 2000

Intraocular Epithelial Downgrowth - Report on 14 Cases from 1986 to 2000A. Bangert1 , A. A. Bialasiewicz2 , K. Engelmann1 , H.-J. Schäfer3 , D. von Domarus4
  • 1Augenklinik mit Poliklinik des Univ.-Krankenhauses Eppendorf, Hamburg
  • 2Dept. of Ophthalmology and School of Ophthalmic Technicians, SQUH, University of Oman, Al-Khod, Muscat/Oman
  • 3Institut für Pathologie des Univ.-Krankenhauses Eppendorf, Hamburg
  • 4Augenabteilung des AK Barmbek, Hamburg
Further Information

Publication History

Manuskript-Eingang: 24. April 2003

Annahme nach Revision: 2. Januar 2004

Publication Date:
30 March 2004 (online)

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Zusammenfassung

Hintergrund: Diffuse und zystische Epithelimplantationen sind seltene, aber vermeidbare potenzielle Erblindungsursachen als Folge von Verletzungen und Operationen. Ziel der Studie ist es, Ursachen und Verlauf von histologisch verifizierten Epithelimplantationen aufzuzeigen. Patienten und Methoden: Von 1986 bis 2000 erfolgten 13 Befundungen (4 von auswärts) im ophthalmopathologischen Labor der Universitäts-Augenklinik Hamburg-Eppendorf. 10 Patienten mit zystischen oder diffusen intraokularen Epithelimplantationen wurden behandelt und 9 Augen operiert. Ergebnisse: Bei Aufnahme hatten 6/10 Patienten einen Visus ≤ 0,1 und 2/10 hatten keine Lichtscheinwahrnehmung. Eine histologisch verifizierte zystische Epithelimplantation lag bei 9/13 Patienten und eine diffuse in 4/13 Fällen vor. Muzinproduktion konnte bei 1/9 intraokularen Epithelimplantationen nachgewiesen werden. Die immunhistologische Untersuchung deckte einmal eine spontane Iriszyste auf. Ursachen waren Trauma (10/14) und Operationen (3/14), im Durchschnitt symptomatisch nach 17 Jahren. Eine kurative Operation wurde bei 13/14 Patienten vorgenommen (5 × Blockexzision, 2 × perforierende Keratoplastik, 1 × Sektoriridektomie, 2 × Enukleation, 3 × auswärts) und verlief rezidivfrei bei einer Nachbeobachtungszeit von im Durchschnitt 4œ Jahren (1 - 12 Jahre). Der postoperative Visus in unserem Patientengut war 5 × gebessert, 2 × verschlechtert, 2 × Anophthalmus. Schlussfolgerungen: Epithelimplantationszysten sind seltene vermeidbare Erblindungsursachen. Die wichtigste Prophylaxe ist eine sorgfältige Primärversorgung mit vollständigem Wundverschluss. Das Visusergebnis hängt von der Ausgangslage ab.

Abstract

Background: Diffuse and cystic epithelial downgrowth occur rarely, but they represent a mostly preventable potential cause of blindness as sequels to trauma and surgery. The aim of this study is to report on the etiology and course of disease in patients with histologically verified epithelial downgrowth. Patients and methods: From 1986 until 2000 the ophthalmopathological laboratory of the University Eye Hospital Hamburg-Eppendorf received 13 (4 external) referrals. Ten patients with cystic of diffuse intraocular epithelial downgrowth were treated and 9 eyes were operated on in the Hospital. Results: At presentation 4/10 patients had a visual acuity of ≤ 0.1, and 2/10 had no light perception. A cystic epithelial downgrowth was verified histologically in 9/13, and a diffuse form in 4/13 patients. Mucin production was proven histochemically in 1/9 intraocular epithelial downgrowth sections. In one case a spontaneous iris cyst was detected by the immunohistological examinations. Trauma (10/14) and surgery (3/14) were the most frequent causes and were symptomatic on average 17 years after the primary event. A curative surgery was done in 13/14 patients (5 × en bloc excision, 2 × penetrating keratoplasty, 1 × iridectomy, 2 × enucleations, 3 × external) resulting in no recurrences during the follow-up of 4œ years (1 - 12 years). The postoperative visual acuity was ameliorated in 5/9, worsened in 2 patients, and 2 were enucleated. Conclusions: Epithelial downgrowth is a rare but preventable cause of blindness. The most important prophylaxis is meticulous primary surgery including a sufficient wound closure. The visual outcome depends on the preoperative conditions.

Schlüsselwörter

Epithelimplantation - Zytokeratine - Blockexzision

Key words

Epithelial downgrowth - cytokeratins - en bloc excision

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Prof. Dr. Alexander A. Bialasiewicz

Prof. & Head, Dept. of Ophthalmology and School of Ophthalmic Technicians, Sultan Qaboos University

123 Al Khod, Muscat

Oman

Phone: 0 09 68-51 41 00

Email: alexander@squ.edu.om