Bakterielle Spätendophthalmitis nach Kunstlinsenimplantation — Eine chronische, IOL-assoziierte „Plastikinfektion“

  • Chr. Hartmann
  • B. Jansen
  • F. Schumacher-Perdreau
  • G. Peters
Conference paper

Zusammenfassung

Koagulasenegative Staphylokokken, insbesondere S. epidermidis, sind die am häufigsten verantwortlichen Erreger bei Infektionen von Kunststoffkathetern und von -implantaten, wie IOL. Die zugrundeliegenden Pathomechanismen sind eher komplex und verlaufen in 5 Schritten.
  1. 1.

    Bakterielle Adhäsion,

     
  2. 2.

    KeimVermehrung,

     
  3. 3.

    Bildung einer Schleimsubstanz (Matrix),

     
  4. 4.

    Protektion gegenüber der Wirtsabwehr und Therapeutika durch diese Matrix und

     
  5. 5.

    Persistenz des Infektionsherdes.

     

In vitro konnten wir nachweisen, daß S. epidermidis an IOL aus PMMA und Silikon in gleich hohem Maße adhärieren. Ferner konnten wir erstmals S. epidermidis wiederholt aus dem Auge eines Patienten mit chronisch rezidivierender Endophthalmitis nach IOL-Implantation isolieren und dessen klonale Identität nachweisen. Der Kunststoff selbst, d. h. die intraokulare Linse aus Plastik, ist ein wesentlicher pathogenetischer Faktor bei der Entstehung der Spätendophthalmitis nach Kunstlinsenimplantation. Aus diesem Grund möchten wir für diese Infektion den Terminus polymerassoziierte Fremdkörper- oder Plastikinfektion oder bezogen auf unser Fach „IOL-assoziierte Endophthalmitis“ vorschlagen.

Summary

Coagulase-negative staphylococci — expencially the species S. epidermidis — are the predominant causative organisms in infections associated with indwelling catheters and implanted foreign bodies. The underlying pathomechanisms are very complex. These bacteria are able to adhere to and to grow on polymer surfaces. In the course of polymer colonisation they produce an extracellular slime substance in which they become completely embedded. The slime protects the staphylococci against host response mechanisms (i.e. opsonophagocytosis) and against antibiotics, and is thus responsible for the maintainance of the infectious focus. There are several literature reports that S. epidermidis may also be involved in late onset endophthalmitis associated with IOL after cataract surgery. However, the etiological correlation could not yet be finally proven because of the possibility of contamination from skin or conjunctival mucous membrane. We could show in vitro using bioluminescence that S. epidermidis is able to adhere to IOL made out of various polymer material. Furthermore we have been able to isolate S. epidermidis after diagnostic aspiration of aqueous humor from a patient with late onset endophthalmitis. At the time of IOL-explantation 4 weeks later we could isolate again S. epidermidis from the aspirate of the aqueous and vitreous humor and from the explanted IOL. The clone identity of the strain isolated could be proven by molecular typing methods. We conclude that late onset endophthalmitis after IOL can be a chronic polymer-associated S. epidermidis infection. Thus we suggest the term “IOL associated endophthalmitis”.

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Copyright information

© Springer-Verlag Berlin Heidelberg 1991

Authors and Affiliations

  • Chr. Hartmann
    • 1
  • B. Jansen
    • 2
  • F. Schumacher-Perdreau
    • 2
  • G. Peters
    • 2
  1. 1.Universitäts-Augenklinik KölnKöln 41Deutschland
  2. 2.Hygiene-InstitutUniversität zu KölnKölnDeutschland

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