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Diagnostik und Therapie der Keratomykose

Keratomycosis: diagnosis and therapy

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Zusammenfassung

Die Diagnose der Keratomykose ist nur in der typischen Form mit pyramidenförmigem Hypopyon, erhabenem, landkartenartigem Infiltrat und Satellitenherden einfach. Bei Kontaktlinsenträgern hingegen lässt sie sich anfänglich klinisch nicht stellen. Daher ist eine Abrasio corneae unumgänglich, die gleichzeitig die Penetration des Antimykotikums in das Hornhautstroma erleichtert. Voriconazol ist derzeit das Mittel der 1. Wahl, wenn man nicht nach mikrobiologischer Diagnostik auf ein spezifisch wirksames Mittel – etwa Posaconazol oder Caspofungin – umstellen möchte. Zur wiederholten intrakameralen bzw. intravitrealen Injektion kann auf Amphotericin B zurückgegriffen werden. Gleichzeitig sind topische Steroide unter spaltlampenmikroskopischer Kontrolle sinnvoll.

Abstract

Diagnosis of fungal keratitis is only straightforward if it presents in its typical form with pyramidal-shaped hypopyon, prominent geographical corneal infiltration and satellites. However, in contact-lens wearers clinical presentation is untypical at early infection. Corneal debridement is therefore necessary, which simultaneously facilitates penetration of the antimycotic into the corneal stroma. At present, voriconazole is the medication of choice, if not changed after microbiological diagnosis to a specifically more potent substance – e.g. posaconazole or caspofungin. Amphotericin B may be used for repeated intracameral or intravitreal injection. Simultaneous application of steroids is useful.

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Danksagung

Für die Aktualisierung der Rezepturen sei Frau Christine Knittel, Zentralapotheke des Universitätsklinikums Magdeburg, gedankt.

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    W. Behrens-Baumann

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Behrens-Baumann, W. Diagnostik und Therapie der Keratomykose. Ophthalmologe 106, 471–481 (2009). https://doi.org/10.1007/s00347-009-1925-1

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