Viral Keratitler
Özet
Bu yazı, körlüğe yol açabilen viral keratitlerin patogenezini, klinik bulgularını, tanısını ve güncel tedavilerini kapsamlı bir şekilde incelemektedir. En sık görülen etken Herpes Simplex Virüs (HSV) olup; epitelyal, stromal, endotelyal ve nörotrofik olmak üzere dört temel formda klinik gösterim sunar. Primer enfeksiyon sonrası duyusal ganglionlarda latent kalan herpes virüs ailesi üyelerinden Varisella Zoster Virüs (VZV) herpes zoster oftalmikus ve psödodentritik keratit tablolarına; Sitomegalovirüs (CMV) ise özellikle sağlıklı bireylerde madeni para şeklinde keratit presipitatları içeren endotelite yol açar. Epstein-Barr Virüs (EBV) multifokal granüler stromal opasitelerle kendini gösterirken, zarfsız bir DNA virüsü olan Adenovirüs (ADV) ise epidemik keratokonjonktivite ve kronik subepitelyal infiltratlara (SEİ) neden olur. Tanı süreçlerinde biyomikroskopik muayenenin yanı sıra PCR, hücre kültürü ve Goldmann-Witmer katsayısı analizi gibi laboratuvar testlerinden yararlanılır. Tedavi yaklaşımlarında gansiklovir, asiklovir ve valasiklovir gibi seçici antiviral ajanlar virüs replikasyonunu baskılarken; stromal tutulumlarda ve immün reaksiyonlarda topikal kortikosteroidler, siklosporin A veya takrolimus gibi immün modülatörler inflamasyonu azaltmak amacıyla tedaviye eklenir. Nörotrofik durumlarda toksik ilaçların kesilmesi ve suni gözyaşı önerilirken, dirençli adenoviral vakalarda ise eksimer lazer fototerapötik keratektomi alternatif bir cerrahi çözüm sunmaktadır.
This text comprehensively examines the pathogenesis, clinical findings, diagnosis, and current treatments of viral keratitis, which can lead to blindness. The most common causative agent is Herpes Simplex Virus (HSV), presenting in four main clinical forms: epithelial, stromal, endotheliit, and neurotrophic. Among the members of the herpesvirus family that remain latent in sensory ganglia after primary infection, Varicella Zoster Virus (VZV) causes herpes zoster ophthalmicus and pseudodendritic keratitis, while Cytomegalovirus (CMV) leads to endotheliitis characterized by coin-shaped keratic precipitates, particularly in healthy individuals. Epstein-Barr Virus (EBV) manifests as multifocal granular stromal opacities, and Adenovirus (ADV), an enveloped-free DNA virus, causes epidemic keratoconjunctivitis and chronic subepithelial infiltrates (SEIs). In addition to biomicroscopic examination, laboratory tests such as PCR, cell culture, and Goldmann-Witmer coefficient analysis are utilized in diagnostic processes. Regarding treatment approaches, selective antiviral agents like ganciclovir, acyclovir, and valacyclovir suppress viral replication, whereas topical corticosteroids or immunomodulators such as cyclosporine A and tacrolimus are added to the therapy to reduce inflammation in stromal involvements and immune reactions. In neurotrophic conditions, discontinuing toxic drugs and using artificial tears are recommended, while excimer laser phototherapeutic keratectomy offers an alternative surgical solution for resistant adenoviral cases.
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