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PRECLUDE® Pericardial Membrane für die Behandlung von perforiertem Hornhautulkus bei Patienten mit systemischen autoimmunentzündlichen Erkrankungen

PRECLUDE® Pericardial Membrane for the management of perforated corneal ulcer in patients with systemic autoimmune inflammation

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Zusammenfassung

Zielsetzung

Die Verwendung von PRECLUDE® Pericardial Membrane, die aus expandiertem Polytetrafluorethylen (e-PTFE, sonst bekannt als Gore-Tex®) besteht, als eine Alternativtherapie für die Behandlung eines perforierten Hornhautulkus bei Patienten mit systemischen autoimmunentzündlichen Erkrankungen wurde evaluiert.

Methoden

Es wurden Krankenberichte von allen Patienten retrospektiv überprüft, die auf unserer Abteilung zwischen Dezember 2009 und Dezember 2013 hospitalisiert wurden und einer chirurgischen Reparatur mit PRECLUDE® Pericardial Membrane wegen eines perforierten Hornhautulkus unterzogen wurden. Bei drei Patienten mit systemischen autoimmunentzündlichen Erkrankungen wurde eine nicht absorbierbare, mikroporöse, wasserdichte 0,1 mm dicke e-PTFE-Membrane zur Schließung des Hornhautulkus benutzt. Ein passender Membranteil wurde zurechtgeschnitten, um den Defekt entsprechend zu überdecken und die erwünschte Gewebeanhaftung zu erzielen. Die Membran wurde mit zahlreichen nicht-resorbierbaren Fäden befestigt.

Ergebnisse

Hornhautperforation wurde mit der e-PTFEMembrane erfolgreich abgedeckt. Keiner der Patienten hatte Schmerzen oder andere Beschwerden. Bei der Verlaufskontrolle wurden keine Anzeichen für Infektionen oder Entzündungen beobachtet. Bei einem Patienten mit Granulomatose mit Polyangiitis und bei einem Patienten mit systemischer Vaskulitis wurde die e-PTFE-Membrane drei Monate nach dem chirurgischen Eingriff entfernt, bei einem Patienten mit Sjögren-Syndrom acht Monate nach dem Eingriff. Die darunter liegende Hornhaut war in allen Fällen dünn, fest, stabil und vollständig vaskularisiert.

Schlussfolgerungen

PRECLUDE® Pericardial Membrane stellte sich als eine sichere und wirksame Alternativmethode für die chirurgische Behandlung eines perforierten Hornhautulkus bei Patienten mit systemischen autoimmunentzündlichen Erkrankungen dar. Bei Risikopatienten, bei denen die Gefahr einer Transplantatabstoßung besteht, könnte dieses Verfahren die Methode der Wahl zum Augenerhalt und zu einer aufgeschobenen Hornhauttransplantation sein. Weitere Studien sind erforderlich, um unsere Ergebnisse zu bestätigen.

Summary

Purpose

To evaluate the use of PRECLUDE® Pericardial Membrane composed of expanded polytetrafluoroethylene (e-PTFE, widely known as Gore-Tex®) as an alternative surgical procedure for the management of perforated corneal ulcer closure in patients with systemic autoimmune inflammation.

Methods

Medical records of all patients who were admitted to our department and underwent surgical repair of perforated corneal ulcer with PRECLUDE® pericardial membrane between December 2009 and December 2013 were retrospectively reviewed. In 3 patients with systemic autoimmune inflammation non-absorbable, microporous, watertight 0.1 mm thick e-PTFE membrane was used for corneal ulcer closure. Proper size of membrane was cut to overlap the defect adequately and to achieve a desired tissue attachment. Membrane was fixated with several non-absorbable sutures.

Results

Corneal perforation was successfully covered with e-PTFE membrane. None of the patients had pain or discomfort. No signs of infections or inflammations were detected on follow-up examinations. Three months after surgical treatment the e-PTPE membrane was removed in patient with granulomatosis with polyangiitis and in patient with systemic vasculitis and eight months after surgery in patient with Sjögren syndrome. Underlying cornea was thin, firm, stable and completely vascularised.

Conclusion

PRECLUDE® Pericardial Membrane was found to be a safe and effective as an alternative surgical procedure for perforating corneal ulcer closure in patients with systemic autoimmune inflammation. In these high risk patients for graft rejections this procedure could be the method of choice for eye preservation and for delayed corneal transplantation. Further studies are necessary to confirm our results.

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Conflict of interest

The authors declare that there are no actual or potential conflicts of interest in relation to this article.

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Authors and Affiliations

  1. Augenabteilung (Vorstand: Prof.Dr.Dr.med. Dušica Pahor), Universitätskrankenhaus Maribor, Ljubljanska 5, 2000, Maribor, Slowenien

    Dušica Pahor

  2. Medizinische Fakultät, Universität Maribor, Maribor, Slowenien

    Artur Pahor &  Dušica Pahor

  3. Abteilung für Rheumatologie, Universitätskrankenhaus Maribor, Maribor, Slowenien

    Artur Pahor

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  1. Artur Pahor
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  2. Dušica Pahor
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Correspondence to Dušica Pahor.

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Pahor, A., Pahor, D. PRECLUDE® Pericardial Membrane für die Behandlung von perforiertem Hornhautulkus bei Patienten mit systemischen autoimmunentzündlichen Erkrankungen. Spektrum Augenheilkd. 28, 160–166 (2014). https://doi.org/10.1007/s00717-014-0227-4

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