gms | German Medical Science

102. Jahrestagung der DOG

Deutsche Ophthalmologische Gesellschaft e. V.

23. bis 26.09.2004, Berlin

Borrelia-associated crystalline keratopathy

Meeting Abstract

  • corresponding author T. Dietrich - Department of Ophthalmology, University of Erlangen-Nuremberg
  • W. Geißdörfer - Department of Clinical Microbiology, Immunology and Hygiene, University of Erlangen-Nuremberg
  • U. Schlötzer-Schrehardt - Department of Ophthalmology, University of Erlangen-Nuremberg
  • C. Hofmann-Rummelt - Department of Ophthalmology, University of Erlangen-Nuremberg
  • L. Holbach - Department of Ophthalmology, University of Erlangen-Nuremberg
  • B. Seitz - Department of Ophthalmology, University of Erlangen-Nuremberg
  • G.O.H. Naumann - Department of Ophthalmology, University of Erlangen-Nuremberg
  • F.E. Kruse - Department of Ophthalmology, University of Erlangen-Nuremberg

Evidenzbasierte Medizin - Anspruch und Wirklichkeit. 102. Jahrestagung der Deutschen Ophthalmologischen Gesellschaft. Berlin, 23.-26.09.2004. Düsseldorf, Köln: German Medical Science; 2004. Doc04dogP 210

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Veröffentlicht: 22. September 2004

© 2004 Dietrich et al.
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Gliederung

Text

Objective

Crystalline keratopathy can be associated with paraproteinaemia or with infection by micro-organisms. We present a patient with crystalline keratopathy with proof of borellia in the corneal stroma.

Methods

Case report of asymmetric bilateral progressive peripheral crystalline keratopathy in a 67-year-old male patient with a history of recurrent iridocyclitis and polyarthritis under immunosuppression. After a paraproteinaemia had been excluded and due to a progressive visual loss to 0.1 in the right eye, we performed a triple procedure. During the postoperative follow-up, deep stromal crystalline deposits recurred, starting in the periphery. After six months, the graft became diffusely cloudy. One year after keratoplasty, the patient presented with a hyperacute stromal graft rejection, and we performed re-keratoplasty à chaud.

Results

By light- and electronmicroscopy we detected spirochaetes in the corneal specimen. By means of PCR proof of bacterial nucleic acid (16S-rDNA) was feasible. The result of amplification could be assigned to the species Borrelia burgdorferi by sequence analysis. Three months after re-keratoplasty, the patient presented with a clear graft under systemic and local antibiotics, local steroids and systemic immunosuppression.

Conclusions

In bilateral peripherally accentuated ring-shaped crystalline keratopathy resistent to conventional therapy a borrelia-associated interstitial keratitis should be ruled out. Diagnosis could be verified by incisional biopsy. Antibiotic treatment with cephalosporines or tetracyclines may prevent a progression or recurrence after keratoplasty.