Zur klinisch-pathologischen Korrelation der mikrobiellen Keratitis und darüber hinaus: Gibt es eine korneale Sepsis?

Zusammenfassung

Mikrobielle, infektiöse, Keratitiden bedingen relevant die Indikation von perforierenden Keratoplastiken. Durch eine akute transplantationsbedürftige Situation ergibt sich eine histopathologische Untersuchung der gesamten Korneadicke. Wenn auch die klinische Diagnose einer infektiösen Keratitis dabei nicht immer zu belegen ist, kann in der Pathologie sehr zur diagnostischen Klärung des klinischen Befundes und der Pathogenese beigetragen werden. Dies gelingt mit dem Einsatz vielfältiger Methoden aus Zytologie, Histochemie, Immunhistologie, Molekularpathologie und selten eingesetzter Elektronenmikroskopie, wodurch es möglich ist, geweblich manifestierte Vor- und Begleiterkrankungen nachzuweisen und die infrage kommenden Erreger anzugeben. Lässt sich eine klinisch-pathologische Korrelation für die Korneaschädigung nicht zufriedenstellend erbringen, stellt sich die Frage, ob ein mutmaßlicher Erreger final gar nicht dafür verantwortlich gewesen ist. Die Pathogenese einer transplantationsbedürftigen Keratitis ist auch experimentell am Menschen bisher nicht vollständig entschlüsselt. Die Entwicklung einer derartigen Keratitis kann zu einer klinischen Symptomatik führen, die auch als „bedrohliche Organdysfunktion“ beschrieben wird, ein Begriff aus der Sepsisforschung. Unter Berücksichtigung aktueller Literatur werden mögliche Übereinstimmungen zwischen Sepsis und mikrobieller Keratitis und ihr Bezug zur Histopathologie diskutiert.

Schlüsselwörter

Kornea - Pathologie - Sepsis - Keratoplastik - Infektiologie - Keratitis

Publication History

Received: 04 January 2022

Accepted: 18 March 2022

Article published online:
20 July 2022

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