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Beidseitiges akutes Engwinkelglaukom im Rahmen einer Hantavirus-Infektion

Bilateral acute angle-closure glaucoma due to an infection with Hantavirus

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Zusammenfassung

Ein schlechter Allgemeinzustand mit hämorrhagischem Fieber und erhöhten Kreatininwerten sollte an eine systemische Infektion mit Hantaviren denken lassen. Dabei kann es selten auch zu okulären Veränderungen kommen. Vor allem Veränderungen des Augeninnendruckes, in dem hier beschriebenen Fall ein beidseitiges Engwinkelglaukom, können durch Ödeme und Hämorrhagien im Ziliarkörper und dadurch bedingter anterolateraler Rotation des Iris-Linsen-Diaphragmas mit Verschluss des Kammerwinkels entstehen. Dabei kann es auch zu einer transienten Myopie kommen. Auch intraretinale Hämorrhagien können auftreten. Die Infektion mit Hantaviren wird in Europa meist durch Rötelmäuse übertragen. Der vorherrschende Typ in Europa ist das Puumalavirus, das zu einer Nephropathia epidemica mit hohem Fieber, Kopfschmerzen, gastrointestinalen Beschwerden und einer eingeschränkte Nierenfunktion bis hin zum Nierenversagen führen kann. Es ist keine spezielle Therapie notwendig, aber eine adäquate symptomatische Therapie ist von großer Bedeutung. Nach überstandener Infektion kann es zu einer vollständigen Erholung kommen. Maßnahmen zur Prophylaxe im Kontakt mit Mäusen und deren Ausscheidungen sollten getroffen werden.

Abstract

A poor general condition of patients with hemorrhagic fever and elevated creatinine should raise suspicion of a systemic infection with Hantavirus. This can often also cause ocular changes. Above all, changes of intraocular pressure, in our case bilateral acute angle-closure glaucoma, due to edema and hemorrhage in the ciliary body result in anterolateral rotation of the iris-lens diaphragm with closure of the chamber angle. It can also cause a transient myopia, and intraretinal hemorrhages can also occur. Hantavirus infection is mostly transmitted through red-backed voles in Europe. The predominant type in Europe is the Puumala virus that can lead to an epidemic nephropathy with high fever, headache, gastrointestinal complaints, and an impaired renal function to the point of renal failure. No specific treatment is needed, but adequate symptomatic therapy is of utmost importance. When the infection has been overcome, complete recovery is possible. Measures for prophylaxis should be taken with respect to contact with mice and their excreta.

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  1. Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Gießen und Marburg GmbH, Friedrichstr. 18, 35392, Gießen, Deutschland

    A. Zimmermann, B. Lorenz & W. Schmidt

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  1. A. Zimmermann
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  2. B. Lorenz
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  3. W. Schmidt
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Zimmermann, A., Lorenz, B. & Schmidt, W. Beidseitiges akutes Engwinkelglaukom im Rahmen einer Hantavirus-Infektion. Ophthalmologe 108, 753–758 (2011). https://doi.org/10.1007/s00347-010-2311-8

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