Das Chamäleon der Keratitis herpetischer Genese – Diagnose und Therapie

Zusammenfassung

Die in Europa häufige Keratitis herpetischer Genese wird meist durch das Herpes-simplex-Virus Typ I (HSV) verursacht und ist in seiner Ausprägung ein Chamäleon. Sie kann i. d. R. erfolgreich behandelt werden, wenn man die verschiedenen, typischerweise einseitigen Ausprägungsformen dieser Krankheit kennt: 1. epitheliale Keratitis (dendritica/geographica), 2. stromale Keratitis (nekrotisierend vs. nicht nekrotisierend = „interstitiell“), 3. Endotheliitis (= „disziforme Keratitis“), 4. sog. „metaherpetische Keratitis“ (= neurotrophe Keratopathie), 5. (vaskularisierte) Hornhautnarben. Das Therapieschema wird bewusst auf die Ausprägungsform abstimmt. Eine begleitende okuläre Hypertension sollte im Akutstadium vornehmlich medikamentös behandelt werden (auf Prostaglandinanaloga verzichten!). Nach Keratoplastik und bei häufigen schweren Keratitisschüben ist die systemische Aciclovir-Applikation (2 × 400 mg/Tag) für mindestens 1 Jahr aktueller Standard!

Abstract

In Europe, herpes simplex virus type I (HSV) is a common cause of keratitis. The disease may be well treated if the ophthalmologtist is aware of the various types of clinical expressions of this typical unilateral chameleon, and treatment is adjusted accordingly. Types of expression include: (i) epithelial keratitis (dendritica/geographica), (ii) stromal keratitis (necrotising vs. non-necrotising = “interstitial keratitis”), (iii) endotheliitis (= “disciform keratitis”), (iv) so-called “metaherpetic keratitis” (= neurotrophic keratopathy), (v) (vascularised) corneal scars. In the acute phase, concomitant ocular hypertension should be treated predominantly without surgery (no prostaglandin analoga!). After keratoplasty and in cases of severe recurrences of herpetic keratitis, systemic aciclovir administration (2 × 400 mg/day) for at least one year is indispensable!

Schlüsselwörter

herpetische Keratitis - Keratitis dendritica - disziforme Keratitis - interstitielle Keratitis - ulzerierende nekrotisierende stromale Keratitis - metaherpetische Keratitis

Key words

herpetic keratitis - dendritic keratitis - disciform keratitis - interstitial keratitis - ulcerating necrotising stromal keratitis - metaherpetic keratitis

• Literatur

• 1 Sundmacher R. Color Atlas of Herpetic Eye Disease. Berlin, Heidelberg: Springer; 2009
• 2 Seitz B, Heiligenhaus A. „Die Herpeskeratitis“ – unterschiedliche Ausprägungsformen erfordern unterschiedliche Therapieansätze. Ophthalmologe 2011; 108: 385-395
• 3 Cook SD, Hill JH. Herpes simplex virus: molecular biology and the possibility of corneal latency. Surv Ophthalmol 1991; 36: 140-148
• 4 Gordon YJ, Romanowski E, Araullo T et al. HSV-1 corneal latency. Invest Ophthalmol Vis Sci 1991; 32: 663-665
• 5 Holbach LM, Asano N, Naumann GO. Infection of the corneal endothelium in herpes simplex keratitis. Am J Ophthalmol 1998; 126: 592-594
• 6 Remeijer L, Osterhaus AD, Verjans GM. Human herpes simplex virus keratitis: the pathogenesis revisited. Ocul Immunol Inflamm 2004; 12: 255-285
• 7 Roizman B, Knipe DM, Whitley RJ. Herpes simplex virus. In: Knipe DM, Howley PM, eds. Fields Virology. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2007: 2502-2507
• 8 Sheridan BS, Knickelbein JE, Hendricks RL. CD8 T cells and latent herpes simplex virus type 1: keeping the peace in sensory ganglia. Expert Opin Biol Ther 2007; 7: 1323-1331
• 9 The Herpetic Eye Disease Study Group. Psychological stress and other potential triggers for recurrence of herpes simplex virus eye infections. Arch Ophthalmol 2000; 118: 1617-1625
• 10 The Herpetic Eye Disease Study Group. A controlled trial of oral acyclovir for the prevention of stromal keratitis or iritis in patients with herpes simplex virus epithelial keratitis. The Epithelial Keratitis Trial. Arch Ophthalmol 1997; 115: 703-712
• 11 The Herpetic Eye Disease Study Group. Acyclovir for the prevention of recurrent herpes simplex virus eye disease. N Engl J Med 1998; 339: 300-306
• 12 Liesegang TJ. Epidemiology of ocular herpes simplex: Natural history in Rochester, Minn, 1950 through 1982. Arch Ophthalmol 1989; 107: 1160-1165
• 13 The Herpetic Eye Disease Study Group. Predictors of recurrent herpes simplex virus keratitis. Cornea 2001; 20: 123-128
• 14 Fiorentzis M, Szentmàry N, Seitz B. Bilaterale vaskularisierte disziforme Hornhautnarbe herpetischer Genese bei einem Kind. Ophthalmologe 2015; 112: 162-165
• 15 Remeijer L, Duan R, van Dun JM et al. Prevalence and clinical consequences of herpes simplex virus type 1 DNA in human cornea tissues. J Infect Dis 2009; 200: 11-19
• 16 Holland EJ, Schwartz GS. Classification of herpes simplex virus keratitis. Cornea 1999; 18: 144-154
• 17 Liesegang TJ. Classification of herpes simplex virus keratitis and anterior uveitis. Cornea 1999; 18: 127-143
• 18 Holbach LM, Font RL, Naumann GO. Herpes simplex stromal and endothelial keratitis. Ophthalmology 1990; 97: 722-728
• 19 De Groot-Mijnes JD, Rothova A, Van Loon AM et al. Polymerase chain reaction and Goldmann-Witmer coefficient analysis are complimentary for the diagnosis of infectious uveitis. Am J Ophthalmol 2006; 141: 313-318
• 20 Schacher S, Garweg JG, Russ C et al. Die Diagnostik der herpetischen Uveitis und Keratouveitis. Klin Monatsbl Augenheilkd 1998; 212: 359-362
• 21 Sundmacher R, Neumann-Haefelin D. Herpes simplex virus isolation from the aqueous of patients suffering from focal iritis, endotheliitis, and prolonged disciform keratitis with glaucoma. Klin Monatsbl Augenheilkd 1979; 175: 488-501
• 22 Naumann GO, Gass J, Font R. Histopathology of herpes zoster ophthalmicus. Am J Ophthalmol 1968; 65: 533-541
• 23 Ozan-Yueksel T, Heinz C, Heiligenhaus A et al. Morphological changes in trabeculectomy specimens in different kinds of uveitis glaucoma. Curr Eye Res 2011; 36: 442-448
• 24 Van der Lelij A, Ooijman FM, Kijlstra A et al. Anterior uveitis with sectoral iris atrophy in the absence of keratitis: a distinct clinical entity among herpetic eye diseases. Ophthalmology 2000; 107: 1164-1170
• 25 Behrens-Baumann W. Herpes-simples-Keratitis. Ein kurzer Überblick zur aktuellen Therapie. Klin Monatsbl Augenheilkd 2010; 227: 388-392
• 26 Collum LM, Benedict-Smith A, Hillary IB. Randomised double-blind trial of acyclovir and idoxuridine in dendritic corneal ulceration. Br J Ophthalmol 1980; 64: 766-769
• 27 Hoh HB, Goldschmidt P, Easty DL. Comparative efficacy of ganciclovir and acyclovir ointment in the treatment of herpes simplex dendritic keratitis. Curr Eye Res 1992; 101: 68-72
• 28 Power WJ, Benedict-Smith A, Hillery M et al. Randomized double-blind trial of bromovinyldeoxyuridine (BVDU) and trifluorothymidine (TFT) in dendritic corneal ulceration. Br J Ophthalmol 1991; 75: 649-651
• 29 Bacon TH, Levin MJ, Leary JJ et al. Herpes simplex virus resistance to acyclovir and penciclovir after two decades of antiviral therapy. Clin Microbiol Rev 2003; 16: 114-128
• 30 Duan R, de Vries RD, van Dun JM et al. Acyclovir susceptibility and genetic characteristics of sequential herpes simplex virus type 1 corneal isolates from patients with recurrent herpetic keratitis. J Infect Dis 2009; 200: 1402-1414
• 31 Sundmacher R. Therapie der herpetischen Erkrankungen des vorderen Augenabschnitts. Klin Monatsbl Augenheilkd 1985; 186: 421-423
• 32 Faulds D, Goa KL, Benfield P. Cyclosporin. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic use in immunoregulatory disorders. Drugs 1993; 45: 953-1040
• 33 Heiligenhaus A, Steuhl KP. Topical cyclosporin A in patients with herpes simplex stromal keratitis. Graefes Arch Clin Exp Ophthalmol 1999; 237: 435-438
• 34 Seitz B, Resch M, Schlötzer-Schrehardt U et al. Histopathology and ultrastructure of human corneas after amniotic membrane transplantation. Arch Ophthalmol 2006; 124: 1487-1490
• 35 Hoffmann S, Szentmáry N, Seitz B. Amniotic membrane transplantation for the treatment of infectious ulcerative keratitis before elective penetrating keratoplasty. Cornea 2013; 32: 1321-1325
• 36 Heiligenhaus A, Bauer D, Meller D et al. Improvement of HSV-1 necrotizing keratitis with amniotic membrane transplantation. Invest Ophthalmol Vis Sci 2001; 42: 1969-1974
• 37 Heiligenhaus A, Li H, Hernandez Galindo EE et al. Management of acute ulcerative and necrotizing herpes simplex and zoster keratitis with amniotic membrane transplantation. Br J Ophthalmol 2003; 87: 1215-1219
• 38 Seitz B, Das S, Sauer R et al. Simultaneous amniotic membrane patch in high-risk keratoplasty. Cornea 2011; 30: 269-272
• 39 Riedel T, Seitz B, Langenbucher A et al. Morphologische Ergebnisse nach exzentrischer perforierender Keratoplastik. Ophthalmologe 2001; 98: 639-646
• 40 Rao SN. Treatment of herpes simplex virus stromal keratitis unresponsive to topical prednisolone 1 % with topical cyclosporine 0.05 %. Am J Ophthalmol 2006; 141: 771-772
• 41 Seitz B, Grütereich M, Cursiefen C et al. Konservative und chirurgische Therapie der neurotrophen Keratopathie. Ophthalmologe 2005; 102: 15-26
• 42 Saravia M, Zapata G, Ferraiolo P et al. Anti-VEGF monoclonal antibody-induced regression of corneal neovascularisation and inflammation in a rabbit model of herpetic stromal keratitis. Graefes Arch Clin Exp Ophthalmol 2009; 247: 1409-1416
• 43 van Rooij J, Rijneveld WJ, Remeijer L et al. Effect of oral acyclovir after penetrating keratoplasty for herpetic keratitis. A placebo-controlled multicenter trial. Ophthalmology 2003; 110: 1916-1919
• 44 Sengler U, Reinhard T, Adams O et al. Herpes simplex virus infection in the media of donor corneas during organ culture: frequency and consequences. Eye 2001; 15: 644-647
• 45 Cockerham GC, Krafft AE, McLean IW. Herpes simpex virus in primary graft failure. Arch Ophthalmol 1997; 115: 586-589
• 46 Gatzioufas Z, Hasenfus A, Gyöngyössy B et al. Repeat corneal graft failure due to graft-to-host herpetic infection. J Ophthalmic Inflamm Infect 2013; 28: 24
• 47 Stavridis E, Gatzioufas Z, Hasenfus A et al. Ping-Pong-Transmission von Herpes-simplex-Virus 1 nach Hornhauttransplantation. Ophthalmologe 2012; 109: 1017-1021
• 48 van Velzen M, van de Vijver D, van Loenen FB et al. Acyclovir prophylaxis predisposes to antiviral-resistant recurrent herpetic keratitis. J Infect Dis 2013; 208: 1359-1365
• 49 Verjans GM, Heiligenhaus A. Herpes simplex virus-induced ocular diseases: Detrimental interaction between virus and host. Curr Immunol Rev 2011; 7: 310-327