Zusammenfassung
Die Konjunktiva ist als schützende Schleimhautbarriere des Sehorgans ein Teilabschnitt
des mit ca. 1,7 Quadratmetern größten menschlichen Organs der Haut. Die Bindehaut
unterliegt damit auch vergleichbaren Alterungsprozessen. Diese Alterungsprozesse lassen
sich auf biologisch bzw. genetisch bedingte Ursachen sowie auf Umwelt- und Lichteinflüsse
zurückführen. Hierdurch bedingte Störungen der Homöostase der konjunktivalen Schleimhautbarriere
tragen u. a. dazu bei, dass im hohen Alter häufiger Tumoren entstehen bzw. maligne
Transformationsprozesse einsetzen. Das Patientenalter zum Zeitpunkt der Befundbeurteilung
und der Tumormanifestation ist daher sowohl für die Klärung der Differenzialdiagnose
als auch die Behandlungsplanung hilfreich. In Abhängigkeit von den klinisch-relevanten
Leitbefunden und dem bisherigen Krankheitsverlauf sind die therapeutischen Möglichkeiten
individuell auszuwählen (inzisionale, exzisionale Biopsie, Kryotherapie, Chemo- oder
Radiotherapie, Exenteratio orbitae usw.). Im hohen Patientenalter sind geriatrische
Aspekte im Behandlungsmanagement zu beachten (Gewebebrüchigkeit, Wundheilungsstörungen,
Multimorbidität, eingeschränkte Patientenadherence).
Abstract
The conjunctiva as a mucous membrane provides a protective barrier to the eye. It
represents a small segment of the skin – the largest organ of the body, which has
a size of about 1.7 square metres. For this reason conjunctival ageing is affected
by equivalent processes as skin ageing. Common causes for these ageing processes are
biological and genetic effects as well as environmental conditions and exposure to
light. The resulting dysfunction in conjunctival homoeostasis and protective function
represent common factors which contribute to increased incidences of tumours and malignant
transformations in elderly patients. At the time of tumour manifestation the patient’s
age is an important parameter for differential diagnosis and regimen strategy. All
therapeutic options (surgical incision or excision, cryotherapy, chemo- or radiotherapy,
exenteratio orbitae etc.) have to be determined individually depending on clinically
relevant findings and previous anamnesis. Due to the patient’s age geriatric aspects
have to be considered in therapeutic management (tissue fragility, wound healing,
multimorbidity, decreased adherence).
Schlüsselwörter
Bindehaut - plastische Chirurgie - Pathologie - okuläre Tumoren - Anatomie - Expertenmeinung
Key words
conjunctiva - plastic surgery - pathology - ocular tumours - anatomy - experts opinion
Literatur
- 1
Basti S, Macsai M S.
Ocular surface squamous neoplasia: a review.
Cornea.
2003;
22 (7)
687-704
- 2
Boehm M D, Huang A J.
Treatment of recurrent corneal and conjunctival intra-epithelial neoplasia with topical
interferon alfa 2b.
Ophthalmology.
2004;
111 (9)
1755-1761
- 3
Chi M J, Baek S H.
Clinical analysis of benign eyelid and conjunctival tumors.
Ophthalmologica.
2006;
220 (1)
43-51
- 4
Damato B, Coupland S E.
Clinical mapping of conjunctival melanomas.
Br J Ophthalmol.
2008;
92 (11)
1545-1549
- 5
Keizer R J, Wolff-Rouendaal de D.
Topical alpha-interferon in recurrent conjunctival papilloma.
Acta Ophthalmol Scand.
2003;
81 (2)
193-196
- 6
Dogru M, Erturk H, Shimazaki J. et al .
Tear function and ocular surface changes with topical mitomycin (MMC) treatment for
primary corneal intraepithelial neoplasia.
Cornea.
2003;
22 (7)
627-639
- 7
Dudney de B W, Malecha M A.
Limbal stem cell deficiency following topical mitomycin C treatment of conjunctival-corneal
intraepithelial neoplasia.
Am J Ophthalmol.
2004;
137 (5)
950-951
- 8 Eisenmenger M, Pötzsch O, Sommer B. Veränderungen im Altersaufbau der Bevölkerung. Statistisches
Bundesamt Bevölkerung Deutschlands bis 2050 Wiesbaden; Statistisches Bundesamt 2006:
17-25
- 9
Espana E M, Prabhasawat P, Grueterich M. et al .
Amniotic membrane transplantation for reconstruction after excision of large ocular
surface neopla-sias.
Br J Ophthalmol.
2003;
86
640-645
- 10
Esquenazi S, Fry C L, Holley E.
Treatment of biopsy proved conjunctival intra-epithelial neoplasia with topical interferon
alfa-2b.
Br J Ophthalmol.
2005;
89
1221-1229
- 11
Ferreri A JM, Ponzoni M, Guidoboni M. et al .
Bacteria-eradicating therapy with doxycycline in ocular adnexal MALT lymphoma: a multicenter
prospective trial.
J Natl Cancer Inst.
2006;
98
1375-1382
- 12
Finger P T, Sedeek R W, Chin K J.
Topical interferon alfa in the treatment of conjunctival melanoma and primary acquired
melanosis complex.
Am J Ophthalmol.
2008;
145 (1)
124-129
- 13
Fuchsluger T A, Hintschich C, Steuhl K P. et al .
Adjuvante lokale Interferon-alpha-2b Therapie bei epithelialen Tumoren der Augenoberfläche.
Ophthalmologe.
2006;
103
124-128
- 14
Fujita K, Miyamoto T, Okada Y. et al .
Expression pattern of sonic hedgehog and effect of topical mitomycin C on its expression
in human ocular surface neoplasms.
Jpn J Ophthalmol.
2008;
52
190-194
- 15
Giaconi J A, Karp C L.
Current treatment options for conjunctival and corneal intraepithelial neoplasia.
Ocul Surface.
2003;
1
66-73
- 16
Giebel J, Woenckhaus C, Fabian M. et al .
Age-related differential expression of apoptosis-related genes in conjunctival epithelial
cells.
Acta Ophthalmol.
2005;
83
471-476
- 17
Gichuhi S, Irlam J J.
Interventions for squamous cell carcinoma of the conjunctiva in HIV-infected individuals.
Cochrane Database of Systematic Reviews.
2007;
2
CD005643
- 18
Guech-Ongey M, Engels E A, Goedert J J. et al .
Elevated risk for squamous cell carcinoma of the conjunctiva among adults with AIDS
in the United States.
Int J Cancer.
2008;
122
2590-2593
- 19
Holbach L M, Pogorelov P, Kruse F E.
Differenzialdiagnose und Therapieoptionen bei Tumoren der Konjunktiva.
Ophthalmologe.
2007;
104
521-539
- 20
Hsu A, Frank S J, Ballo M T. et al .
Postoperative adjuvant external-beam radiation therapy for cancers of the eyelid and
conjunctiva.
Ophthal Plast Reconstr Surg.
2008;
24 (6)
444-449
- 21
Huerva V, Mateo A J, Mangues I. et al .
Short-term mitomycin C followed by long-term interferon alpha2beta for conjunctiva-cornea
intraepithelial neoplasia.
Cornea.
2006;
25
1220-1223
- 22
Kaeser P F, Uffer S, Zografos L. et al .
Tumors of the caruncle: A clinicopathologic correlation.
Am J Ophthalmol.
2006;
142
448-455
- 23
Khokhar S, Soni A, SinghSethi H. et al .
Combined surgery, cryotherapy and mitomycin c for recurrent ocular surface squamous
neoplasia.
Cornea.
2002;
21
189-191
- 24
Kiratli H, Shields C L, Shields J A. et al .
Metastatic tumours to the conjunctiva: report of 10 cases.
Br J Ophthalmol.
1996;
80 (1)
5-8
- 25
Kurli M, Finger P T.
Topical mitomycin chemotherapy for conjunctival malignant melanoma and primary acquired
melanosis with atypia: 12 years’ experience.
Graefes Arch Clin Exp Ophthalmol.
2005;
243 (11)
1108-1114
- 26
Lee G A, Hirst L W.
Ocular surface squamous neoplasia.
Surv Ophthalmol.
1995;
39
1108-1114
- 27
Loeffler K U, Perlamn J I.
Diffuse intraepithelial sebaceous carcinoma of the conjunctiva.
Br J Ophthalmol.
1997;
81
168
- 28
Luthra C L, Doxanas M T, Green W R.
Lesions of the caruncle: a clinicohisto-pathologic study.
Surv Ophthalmol.
1978;
23
183-195
- 29
McKelvie P A, Daniell M.
Impression cytology following mitomycin C therapy for ocular surface squamous neoplasia.
Br J Ophthalmol.
2001;
85
1115-1119
- 30
Morgenstern K E, Givan J, Wiley L A.
Long-term administration of topical inter-feron alfa-2beta in the treatment of conjunctival
squamous papilloma.
Arch Ophthalmol.
2003;
121 (7)
1052-1053
- 31
Nolan G R, Hirst L W, Bancroft B J.
The cytomorphology of ocular surface squamous neoplasia by using impression cytology.
Cancer Cytopathol.
2001;
93
60-67
- 32
Peksayar G, Altan-Yaycioglu R, Onal S.
Excision and cryosurgery in the treatment of conjunctival malignant epithelial tumours.
Eye.
2003;
17 (2)
228-232
- 33
Pompeu A C, Arap S, Silva M N. et al .
Ocular metastasis as first presentation of renal cell carcinoma: report of 2 cases.
Clinics.
2005;
60 (1)
75-78
- 34
Poothullil A M, Colby K A.
Topical medical therapies for ocular surface tumors.
Seminars in Ophthalmology.
2006;
21
161-169
- 35
Rohrbach J M.
Ophthalmopathologie zwischen gestern und morgen.
Klin Monatsbl Augenheilkd.
2004;
221
87-91
- 36
Rohrbach J M, Auw-Hädrich C, Messmer E M. et al .
Zur Situation der Ophthalmopathologie in Deutschland: eine aktuelle Bestandsaufnahme.
Klin Monatsbl Augenheilkd.
2009;
226
740-746
- 37
Rudolph P.
Melanozytäre Tumoren.
Pathologe.
2002;
23
89-96
- 38
Schallenberg M, Niederdräing N, Steuhl K P. et al .
Topisches Mitomycin C als Therapie konjunktivaler Tumore.
Ophthalmologe.
2008;
105
777-784
- 39
Shields C L, Shields J A.
Conjunctival nevi. Clinical features and natural course in 410 consecutive patients.
Arch Ophthalmol.
2004;
122
167-175
- 40
Shields C L, Shields J A.
Conjunctival tumors in children.
Current Opinion in Ophthalmology.
2007;
18
351-360
- 41
Shields C L, Shields J A, Carvalho C. et al .
Conjunctival lymphoid tumors: clinical analysis of 117 cases and relationship to systemic
lymphoma.
Ophthalmology.
2001;
108
979-984
- 42
Shields C L, Lally M R, Singh A D. et al .
Oral cimetidine (Tagamet) for recalcitrant, diffuse conjunctival papillomatosis.
Am J Ophthalmol.
1999;
128 (3)
362-364
- 43
Shields C L, Naseripour M, Shields J A.
Topical mitomycin c for extensive, recurrent conjunctival-corneal squamous cell carcinoma.
Am J Ophthalmol.
2002;
133
601-606
- 44
Shields J A, Shields C L, Eagle R C. et al .
Diffuse ocular metastases as an initial sign of metastatic lung cancer.
Ophthalmic Surg Lasers.
1998;
29 (7)
598-601
- 45
Singh A D, De Potter P, Fijal B A. et al .
Lifetime prevalence of uveal melanoma in white patients with oculo (dermal) melanocytosis.
Ophthalmology.
1998;
105
195-198
- 46
Sjö N C, Buchwald von C, Cassonnet P. et al .
Human papillomavirus in normal conjunctival tissue and in conjunctival papilloma:
types and frequencies in a large series.
Br J Ophthalmol.
2007;
91
1014-1015
- 47
Sjö L D.
Ophthalmic lymphoma – epidemiology and pathogenesis.
Acta Ophthalmol.
2009;
87 (Suppl)
5-24
- 48
Stone D U, Butt A I, Chodosh J.
Ocular surface squamous neoplasia. A standard of care survey.
Cornea.
2005;
24
297-300
- 49
Timm A, Stropahl G, Schittkowski M. et al .
Assoziation von malignen Bindehauttumoren und HIV Infektion in Kinshasa.
Ophthalmologe.
2004;
101
1011-1016
- 50
Tokuyama J, Kubota T, Otani Y. et al .
Rare case of early mucosal gastric cancer presenting with metastasis to the bulbar
conjunctiva.
Gastric Cancer.
2002;
5 (2)
102-126
- 51
Tost F, Lehnigk U, Maile S. et al .
Molekulare Aspekte der Alterung des normalen Bindehautepithels – Zur Bedeutung apoptoseassoziierter
Gene.
Ophthalmologe.
2005;
102
133-139
- 52
Zaki A A, Farid S F.
Management of Intraepithelial and Invasive Neoplasia of the Cornea and Conjunctiva:
A Long-term Follow Up.
Cornea.
2009;
28
986-988
Prof. Dr. Frank HW Tost
Augenklinik am Universitätsklinikum, Ernst-Moritz-Arndt-Universität
Ferdinand-Sauerbruch-Str.
17475 Greifswald
Telefon: ++ 49/38 34/86 59 23
Fax: ++ 49/38 34/86 59 50
eMail: tost@uni-greifswald.de
