Artikel
Borrelia-associated crystalline keratopathy
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Veröffentlicht: | 22. September 2004 |
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Gliederung
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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.