Fertőzéses keratitisek diagnosztikája és kezelése

Abstract

We summarize up-to-date diagnostic and treatment of infectious keratitis using literature data and some clinical examples. In the clinical practice, most commonly bacterial, herpetic, mycotic and acanthamoeba keratitis occur. Beside slitlamp examination, for diagnostic purpose, we analyse corneal sensitivity, perform in vivo confocal microscopy, polymerase-chain-reaction (PCR), in vitro culture and histological examination of the corneal sample. As conservative treatment we use primarily topical moxifloxacin or cephasolin with fortified tobramycin or gentamycin in bacterial, topical antiviral gel (in some cases in combination with systemic antiviral treatment) in part in combination with topical corticosteroids in herpetic, voriconasole or amphotericin-B in mycotic, and topical-triple-therapy (diamidine, biguanid and antibiotics) in acanthamoeba keratitis. In case of early diagnosis and initiation of topical therapy, most cases of infectious keratitis recover successfully. However, beside conservative treatment, penetrating keratoplasty, amniotic membrane transplantation and crosslinking therapy may be necessary. Crosslinking is solely contraindicated in herpetic keratitis. Orv Hetil. 2017; 158(31): 1203-1212.