Autor:innen:
Sadiq Said (Zürich | CH)
Daniel Rudolf Muth (Zurich | CH)
Daniel Barthelmes (Zurich | CH)
Timothy Hamann (Zurich | CH)
Anahita Bajka (Zurich | CH)
Maximilian Robert Justus Wiest (Zurich | CH)
Sandrine Zweifel (Zurich | CH)
Frank Blaser (Zurich | CH)
Background:
To expand the existing knowledge on the rare clinical entity of linear interstitial keratitis.
History and Signs:
This case series includes four healthy patients aged 10, 18, 20, and 21 years at the initial referral to our ophthalmology department at the University Hospital Zurich in Switzerland. All patients reported a sudden onset of painful red eye, with only Case 3 using corrective contact lenses. In the acute phase, all patients were suspected of having unilateral keratitis with conjunctival injection, corneal epithelial defects, and linear stromal opacities, with Case 2 additionally showing anterior chamber reaction and Case 3 exhibiting nummular keratitis. In each patient, we performed diagnostic corneal swabs for common bacteria, fungi, and viruses, all of which were inconclusive. We further assessed autoimmune serological markers and screened for HIV, hepatitis B and C, and syphilis in Cases 1, 3, and 4, and performed in vivo confocal microscopy in Case 2. While infectious screening was negative, we detected antinuclear antibodies in Cases 3 and 4.
Therapy and Outcome:
Case 1 displayed recurrent keratitis, ultimately leading to corneal perforation after mild ocular trauma, which we treated conservatively using bandage contact lenses with topical and systemic antibiotic coverage. At a follow-up five years after the initial presentation, the corrected visual acuity deteriorated from 0.6 LogMAR to 0.5 LogMAR. Case 2 showed pan-stromal corneal inflammation on in vivo confocal microscopy. In Cases 3 and 4, there was no clinical evidence of underlying rheumatologic disease. We treated all three patients using topical antibiotics, lubricating and corticosteroid-containing eye drops, and in Cases 2 and 4 additional antiviral agents due to initially suspected herpetic origin. The corrected visual acuity deteriorated from 0 LogMAR to 0.3 LogMAR in Case 2 and improved from 0.3 LogMAR in Case 3 and 0.6 LogMAR in Case 4 to 0 LogMAR in both patients.
Conclusions:
Linear interstitial keratitis remains a rare entity. It seems to preferably affect adolescent patients. Future research should include autoimmune workup to reveal unknown causal relationships. Long-term patient follow-up is paramount to detect disease recurrence and activity, finally minimizing the risk for corneal rupture.