Hornhauteinschmelzung nach Cross-Linking und tiefer lamellärer Keratoplastik („DALK”) bei Keratokonus

 

 Buy Article Permissions and Reprints

Zusammenfassung

Wir stellen den Fall einer 45-jährigen Patientin mit schwerer Atopie und Keratokonus vor, bei der es nach Cross-Linking und tiefer anteriorer lamellärer Keratoplastik (DALK) zu einer progredienten Hornhauteinschmelzung aufgrund einer subklinischen Infektion mit Herpes-simplex-Virus kam. Eine perforierende Keratoplastik und intensive antivirale und immunsuppressive Behandlung waren zur Kontrolle der Infektion notwendig. Diese Fallbeschreibung zeigt die Schwierigkeiten auf, die bei der Behandlung von Patienten mit Keratokonus und schwerer Atopie auftreten können.

Abstract

We present the case of a 45-year-old patient with severe atopic disease and keratokonus who suffered from corneal melting following cross-linking and deep anterior lamellar keratoplasty (DALK) due to subclinical infection with Herpes simplex virus (HSV). Penetrating keratoplasty and intensive antiviral and immunosuppressive medical treatment were necessary to control the infection. The case demonstrates the difficulties in the treatment of keratokonus in patients with severe atopic disease.

Literatur

• 1 Daniell M D, Dart J K, Lightman S. Use of cyclosporin in the treatment of steroid resistant post-keratoplasty atopic sclerokeratitis.  The British journal of ophthalmology. 2001;  85 91-92
  Google Scholar
• 2 Easty D, Entwistle C, Funk A. et al . Herpes simplex keratitis and keratoconus in the atopic patient. A clinical and immunological study.  Transactions of the ophthalmological societies of the United Kingdom. 1975;  95 267-276
  Google Scholar
• 3 Harrison R J, Klouda P T, Easty D L. et al . Association between keratoconus and atopy.  The British journal of ophthalmology. 1989;  73 816-822
  Google Scholar
• 4 Lyons C J, Dart J K, Aclimandos W A. et al . Sclerokeratitis after keratoplasty in atopy.  Ophthalmology. 1990;  97 729-733
  Google Scholar
• 5 Prabriputaloong T, Margolis T P, Lietman T M. et al . Atopic disease and herpes simplex eye disease: a population-based case-control study.  American journal of ophthalmology. 2006;  142 745-749
  Google Scholar
• 6 Rahi A, Davies P, Ruben M. et al . Keratoconus and coexisting atopic disease.  The British journal of ophthalmology. 1977;  61 761-764
  Google Scholar
• 7 Reinhard T, Sundmacher R. Perforating keratoplasty in endogenous eczema. An indication for systemic cyclosporin A - a retrospective study of 18 patients.  Klin Monatsbl Augenheilkd. 1992;  201 159-163
  Google Scholar
• 8 Reinhard T, Moller M, Sundmacher R. Penetrating keratoplasty in patients with atopic dermatitis with and without systemic cyclosporin A.  Cornea. 1999;  18 645-651
  Google Scholar
• 9 Reinhard T, Ruzicka T, Sundmacher R. Pathogenesis, clinical aspects and therapy of eye involvement in allergy.  Ophthalmologe. 1999;  96 473-488
  Google Scholar
• 10 Rezende R A, Hammersmith K, Bisol T. et al . Comparative study of ocular herpes simplex virus in patients with and without self-reported atopy.  American journal of ophthalmology. 2006;  141 1120-1125
  Google Scholar
• 11 Sullivan L J, Su C, Snibson G. et al . Sterile ocular inflammatory reactions to monofilament suture material.  Australian and New Zealand journal of ophthalmology. 1994;  22 175-181
  Google Scholar
• 12 Sundmacher R, Reinhard T. Cyclosporin A in perforating keratoplasty.  Cesk Slov Oftalmol. 1995;  51 271-276
  Google Scholar
• 13 Tomita M, Shimmura S, Tsubota K. et al . Postkeratoplasty Atopic Sclerokeratitis in Keratoconus Patients.  Ophthalmology. 2007;  Epub ahead of print
  Google Scholar

Dr. Philipp Eberwein

Augenheilkunde, Universitätsklinik Freiburg

Killianstr. 5

79106 Freiburg

Phone: ++ 49/7 61/2 70 40 01

Fax: ++ 49/7 61/2 70 41 35

Email: philipp.eberwein@uniklinik-freiburg.de