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Analyse der okulären Oberfläche nach Protonenbestrahlung bei malignem Melanom der Bindehaut

Analysis of ocular surface alterations following proton beam radiation in eyes with conjunctival malignant melanoma

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Zusammenfassung

Hintergrund

Bei großflächiger, diffuser oder multilokulärer Ausdehnung des Bindehautmelanoms kann die Protonenbestrahlung bei bestimmten Indikationen eine mögliche Alternative zur Exenteratio darstellen. Bei ausgedehnten Tumoren kann es in der Folge zu Problemen der Augenoberfläche und der Tränenproduktion kommen. In dieser Studie untersuchten wir die Beschaffenheit der Augenoberfläche von 10 Patienten, die zwischen 1996 und 2002 mit Protonen behandelt worden waren.

Methode

Die Patienten wurden im Rahmen der Nachbeobachtung untersucht. Dabei waren 8 der 10 durch Protonenbestrahlung behandelten Fälle Melanomrezidive, die zuvor bereits adjuvant vorbehandelt worden waren. Neben der ophthalmologischen Grunduntersuchung wurde eine ausführliche Tränenfilmdiagnostik und Analyse der okulären Oberfläche durchgeführt.

Ergebnisse

Der Nachbeobachtungszeitraum betrug 17 bis 87 Monate (Mittel 40,9±20,1). Bei 6 Patienten wurden mehr als 50% des Ober- und Unterlids in das Strahlenfeld eingeschlossen. Bei diesen lag in allen Fällen eine mittlere bis schwere Sicca-Symptomatik vor. Die Impressionszytologie der Bindehaut zeigte eine squamöse Metaplasie in 9 von 10 Fällen.

Schlussfolgerungen

Die squamöse Metaplasie der konjunktivalen Epithelien deutet auf eine radiogene, dauerhafte Differenzierungsstörung der konjunktivalen Zellverbände hin. Die Tränenfilminstabilität korreliert mit dem Verlust von muzinbildenden Becherzellen und der Atrophie von Meibom’schen Drüsen.

Abstract

Background

In cases of large, diffuse or multilocular growth pattern of conjunctival melanoma, proton beam irradiation can serve as an alternative therapy to exenteration. In extended tumours, ocular surface problems can result after therapy. In this study we examined ocular surface integrity of ten patients who underwent proton beam radiation between 1996 and 2002.

Methods

The patients were examined during their follow-up. Eight of the ten cases who underwent proton radiotherapy were recurrent tumours, which were previously treated with other adjuvant therapies. We performed a standard ophthalmological examination and detailed tear film diagnostics.

Results

The follow-up was 17–87 months (mean: 40.9±20.1). In six cases more than 50% of the upper and lower eyelids were included in the radiation field. All of these cases showed moderate to severe sicca symptoms. The impression cytology revealed squamous metaplasia of conjunctival cells in nine of ten cases.

Conclusions

Squamous metaplasia of conjunctival epithelia indicates a radiogenic, persisting disturbance of differentiation of the conjunctival epithelial cells. The tear film instability correlates with the loss of mucin-secreting goblet cells and meibomian gland dysfunction.

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Authors and Affiliations

  1. Zentrum für Augenheilkunde, Universitätsklinikum, Hufelandstraße 55, 45122 , Essen

    H. Westekemper, G. Anastassiou, N. Bornfeld, K.-P. Steuhl & D. Meller

  2. Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum, Essen

    W. Sauerwein

  3. Centre Antoine Lacassagne, Nizza, Frankreich

    P. Chauvel

Authors
  1. H. Westekemper
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  2. G. Anastassiou
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  3. W. Sauerwein
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  4. P. Chauvel
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  5. N. Bornfeld
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  6. K.-P. Steuhl
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  7. D. Meller
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Correspondence to H. Westekemper.

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Westekemper, H., Anastassiou, G., Sauerwein, W. et al. Analyse der okulären Oberfläche nach Protonenbestrahlung bei malignem Melanom der Bindehaut. Ophthalmologe 103, 588–595 (2006). https://doi.org/10.1007/s00347-006-1341-8

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  • DOI: https://doi.org/10.1007/s00347-006-1341-8

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