Zusammenfassung
Hintergrund: Die Tiefenausdehnung von Xanthelasmen hat entscheidende Bedeutung für die Wahl eines
geeigneten Operationsverfahrens. Operative Befunde lassen vermuten, dass Xanthelasmen
entgegen bisheriger Berichte keinesfalls auf die oberflächliche Dermis beschränkt
bleiben, sondern durchaus die gesamte Dermis durchsetzen und bis in die Orbicularismuskulatur
reichen können. In der vorliegenden Untersuchung wurde die Tiefenausdehnung von Xanthelasmen
an histologischen Präparaten gemessen. Material und Methode: Wir werteten 100 Xanthelasmen aus, die zwischen 1993 und 2006 bei 78 Patienten chirurgisch
entfernt wurden. Histologische Schnitte des exzidierten Gewebes wurden lichtmikroskopisch
untersucht und die Tiefenausdehnung der Xanthelasmen mit dem digitalen Bildanalysesystem
AnalySIS® von Soft Imaging System gemessen. Die Messung erfolgte vom Übergang Epidermis/Dermis
zu der am tiefsten liegenden „Xanthelasma”-Zelle (fetthaltiger Makrophage). Zudem
wurde die Tiefenausdehnung danach unterschieden, ob die Xanthelasmen bis in die Dermis,
bis angrenzend an oder bis in das Stratum musculare hinein reichten. Ergebnisse: Die Dicke der Xanthelasmen lag zwischen 502,9 µm und 4429,5 µm (m = 1443,6 µm, M
= 1333,6 µm, SD 716,1). In 58 % der Präparate reichten die Fettablagerungen bis in
die Dermis (m = 1275,9 µm, SD 571,0), in 15 % der Präparate grenzten sie bis an das
Stratum musculare (m = 1426,2 µm, SD 534,8) und in 27 % der Präparate reichten sie
hinein (m = 1813,4 µm, SD 937,6). Schlussfolgerung: Unsere Untersuchungen bestätigen die Vermutung, dass ein beträchtlicher Teil, nämlich
42 % der Xanthelasmen, vollständig durch die Dermis reichen und an das Stratum musculare
angrenzen oder sogar hineinreichen. Diese Xanthelasmen sollten nicht durch eine oberflächliche
Lasertherapie behandelt, sondern besser chirurgisch exzidiert werden.
Abstract
Background: The depth of tissue invasion of xanthelasma is of major importance in selecting the
most suitable surgical procedure. Intraoperative findings let one assume, that despite
the common presumption, xanthelasma are not limited to the superior dermis but that
they may penetrate the entire dermis and reach into the orbicularis muscle. In this
study the depth of tissue invasion of xanthelasma was measured in histological specimens.
Materials and Methods: Between 1993 and 2006 100 xanthelasmata of 78 patients were surgically removed and
analysed. Histological specimens were examined by light microscopy and the depth of
tissue invasion by fat-containing macrophages was measured using the digital picture
analysis system AnalySIS® of Soft Imaging System Inc. The distance from the epidermis/dermis
junction to the deepest ”xanthelasma” cell (fat-containing macrophage) was measured.
In addition, we classified the cases into 3 categories: 1) invasion into the dermis,
2) invasion adjacent to and 3) invasion into the stratum musculare. Results: The thickness of the xanthelasmata ranged between 502.9 µm und 4429.5 µm (m = 1443.6
µm, M = 1333.6 µm, SD 716.1). In 58 % of specimens lipid-containing macrophages infiltrated
the dermis (m = 1275.9 µm, SD 571.0), in 15 % of specimens they touched the stratum
musculare (m = 1426.2 µm, SD 534.8) and in 27 % of specimens they even infiltrated
this layer (m = 1813.4 µm, SD 937.6). Conclusions: This study confirms our hypothesis that a significant part, namely 42 % of the xanthelasmata,
infiltrates the entire dermis and reaches the stratum musculare or even invades into
this layer. These xanthelasmata should not be treated by superficial laser therapy
but should be better excised surgically.
Schlüsselwörter
Auge - Tumor - Xanthelasma - Histologie - Therapie - Laser
Key words
eye - tumour - xanthelasma - histology - treatment - laser
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Prof. Dr. Hans Mittelviefhaus
Universitäts-Augenklinik Freiburg
Killianstr. 5
79106 Freiburg
Phone: ++ 49/7 61/2 70 40 21
Fax: ++ 49/7 61/2 70 40 45
Email: hans.mittelviefhaus@uniklinik-freiburg.de
