Spektrum der Augenheilkunde

, Volume 28, Issue 6, pp 234–237 | Cite as

Causes of sterile vitritis in the setting of Boston keratoprosthesis

original article
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Summary

An idiopathic inflammation of the vitreous humor, “sterile vitritis”, has been observed in some keratoprosthesis recipients, typically months to years after implantation. Its etiology is unclear. Potential mechanisms include: (i) local tissue destruction and inflammation around the prosthesis, at the point of contact between cornea donor tissue and the device, (ii) microbial cell wall or nucleic acid triggering inflammation, and (iii) a systemic immune response with ocular manifestations.

One or more of these mechanisms likely contributes to each case of idiopathic vitreous inflammation. Tissue remodeling around the keratoprosthesis may create a dynamic space for inorganic or organic debris to enter the eye. Some cases of vitritis may have an infectious origin, despite negative cultures. Continued studies are needed to assess the clinical significance of corneal tissue loss under the front plate and adjacent to the stem. These areas of tissue “gaps” may provide access for organic and inorganic debris to enter the eye and stimulate inflammation.

Keywords

Boston Keratoprosthesis Sterile inflammation Sterile vitritis 

Ursachen der sterilen Vitritis im Zusammenhang mit Boston-Keratoprothesen

Zusammenfassung

Eine idiopathische Entzündung des Glaskörpers, die sogenannte sterile Vitritis, konnte bei einigen Patienten Monate bis Jahre nach Implantation einer Boston-Keratoprothese beobachtet werden. Die Ätiologie ist unklar. Mögliche Ursachen umfassen: (I) lokale Gewebszerstörungen und -entzündungen im Kontaktbereich zwischen der Spenderkornea und der Keratoprothese, (II) entzündungsauslösende Nukleinsäuren bzw. mikrobielle Zellwände, sowie (III), okuläre Manifestationen einer systemischen Immunantwort.

Bei idiopathischen Glaskörperentzündungen spielen wohl einer oder auch mehrere der genannten Mechanismen eine Rolle. Gewebeumbau im Bereich der Keratoprothese könnte zur Ausbildung eines dynamischen Zwischenraumes führen, der organischen und anorganischen Ablagerungen als Eintrittsweg in das Auge dient. Trotz unauffälliger Kultur könnten einige der Vitritiden einen infektiösen Ursprung haben. Deswegen sind weitere Studien erforderlich, um die klinische Bedeutung der Minimierung des Korneagewebes unter der Frontplatte und in Nähe des Schafts zu untersuchen. Die Bereiche des Gewebeumbaus und der damit assoziierten „Gewebsspalten“ stellen vermutlich die Eintrittswege für organische und anorganische Ablagerungen dar und stimulieren Entzündungsprozesse.

Schlüsselwörter

Boston-Keratoprothese Sterile Entzündung Sterile Vitritis 
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Notes

Conflict of interest

The authors declare that there is no conflict of interest.

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Copyright information

© Springer-Verlag Wien 2014

Authors and Affiliations

  1. 1.Department of OphthalmologyMassachusetts Eye and Ear Infirmary and Harvard Medical SchoolBostonUSA

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