Amnionmembrantransplantation bei herpetischen Hornhautinfektionen

 

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Zusammenfassung

Schwere infektiöse Hornhautulzerationen, unter anderem mit herpetischer Genese, führen in der Regel zur deutlichen Beeinträchtigung der Sehschärfe bis hin zur Erblindung. Die Behandlung richtet sich nach der Grunderkrankung und erfordert neben einer breiten medikamentösen Therapie die Entwicklung chirurgischer Strategien zur Wiederherstellung der Integrität der kornealen Augenoberfläche. Herpetisch bedingte persistierende Hornhautepitheldefekte mit oder ohne Ulzeration bis hin zur Entwicklung einer neurotrophen Keratopathie mit dem Risiko der Perforation der Hornhaut stellen immer noch eine klinische Herausforderung in der Ophthalmochirurgie dar. Seit Einführung moderner Konservierungsmethoden Mitte der 1990er-Jahre hat die unter sterilen Bedingungen nach Kaiserschnitt gewonnene innerste Schicht der Plazenta, die Amnionmembran (AM) als Basalmembranersatz eine Renaissance erlebt und ist heute in der rekonstruktiven Chirurgie der Augenoberfläche kaum wegzudenken. Die vielfältigen, mittlerweile etablierten Einsatzmöglichkeiten der AM reichen von einem Transplantat („Graft”), natürlichen Verband („Patch”) bis hin zum Kultursubstrat („Carrier”) für die Ex-vivo-Züchtung von okulärem Oberflächenepithel. In diesem Übersichtsartikel sollen die Grundlagen und die klinische Applikation der Amnionmembrantransplantation (AMT) in der Behandlung von Hornhautinfektionen durch Herpes-Simplex-Virus und Varizella-Zoster-Virus beschrieben werden.

Abstract

Severe infectious corneal ulceration such as herpetic stromal keratitis commonly causes loss of vision and may lead to blindness. Treatment depending on the underlying disease includes antimicrobial medication and the development of surgical strategies to restore the integrity of the corneal ocular surface. Ulcerative herpetic stromal keratitis and/or neurotrophic keratopathy with the risk of corneal perforation are still clinically challenging conditions in ophthalmic surgery of the ocular surface. Since the introduction of newly developed preservation methods, amniotic membrane (AM) functioning as a basement membrane substitute has gained widespread popularity in ocular surface reconstruction. Various ways of clinical application such as the use of AM as a graft, patch or culture substrate and carrier system to expand ocular surface epithelia have been recently reported. In this article, the basis and clinical application of amniotic membrane transplantation for the management of corneal infections with Herpes simplex and Herpes zoster virus are reviewed.

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Prof. Dr. Daniel Meller

Zentrum für Augenheilkunde, Klinik für Erkrankungen des vorderen Augenabschnitts, Universität Duisburg-Essen

Hufelandstraße 55

45122 Essen

Phone: ++ 49/7 23/8 43 82

Fax: ++ 49/7 23/56 45

Email: Daniel.Meller@uk-essen.de