Akanthamöbenkeratitis – klinische Zeichen, Diagnose, Therapie

Gräulich-schmutzige Epithelveränderungen, Perineuritis, multifokale stromale Infiltrate und ein Ringinfiltrat sind typischerweise Schlagwörter für die Akanthamöbenkeratitis. In der Regel wird über ein Jahr hinweg eine Dreifachbehandlung aus Polyhexamid, Propamidinisoethionat, Neomycin empfohlen. Kryotherapie, Amnionmembrantransplantation, Riboflavin-UVA-Crosslinking und Keratoplastik sind die Alternativen bei Fällen, bei denen eine lokale Behandlung keine Besserung zur Folge hat.

• Literatur

• 1 Meltendorf C, Duncker G. Akanthamöben-Keratitis. Klin Monatsbl Augenheilkd 2011; 228: R29-R43
• 2 Szentmáry N, Göbels S, Matoula P. et al. Die Akanthamöbenkeratitis – ein seltenes und oft spät diagnostiziertes Chamäleon. Klin Monatsbl Augenheilkd 2012; 229: 521-528
• 3 Dart JK, Saw VP, Kilvington S. Acanthamoeba keratitis: diagnosis and treatment update 2009. Am J Ophthalmol 2009; 148: 487-499
• 4 Daas L, Viestenz A, Schnabel P. et al. Confocal microscopy in acanthamoeba keratitis as an early relapse-marker. Clin Anat 2017;
• 5 Daas L, Szentmáry N, Eppig T. et al. Das Deutsche Akanthamöbenkeratitis-Register – Erste Ergebnisse einer multizentrischen Erhebung. Ophthalmologe 2015; 112: 752-763
• 6 Pfister DR, Cameron JD, Krachmer JH. et al. Confocal microscopy findings of Acanthamoeba keratitis. Am J Ophthalmol 1996; 121: 119-128
• 7 Mathers WD, Sutphin JE, Folberg R. et al. Outbreak of keratitis presumed to be caused by Acanthamoeba. Am J Ophthalmol 1996; 121: 129-142
• 8 Aspöck H. Grundzüge der Diagnostik. In: Hiepe T, Lucius R, Gottstein B. Allgemeine Parasitologie mit den Grundzügen der Immunologie, Diagnostik und Bekämpfung. Stuttgart: Parey in MVS Medizinverlage; 2006: 339-457
• 9 Sharma S, Athmanathan S, Atha-Ur-Rasheed M. et al. Evaluation of immunoperoxidase staining technique in the diagnosis of Acanthamoeba keratitis. Indian J Ophthalmol 2001; 49: 181-186
• 10 Claerhout I, Goegebuer A, Van Den Broecke C. et al. Delay in diagnosis and outcome of Acanthamoeba keratitis. Graefes Arch Clin Exp Ophthalmol 2004; 242: 648-653
• 11 Awwad ST, Petroll WM, McCulley JP. et al. Updates in Acanthamoeba keratitis. Eye Contact Lens 2007; 33: 1-8
• 12 Perry HD, Donnenfeld ED, Foulks GN. et al. Decreased corneal sensation as an initial feature of Acanthamoeba keratitis. Ophthalmology 1995; 102: 1565-1568
• 13 Patel DV, McGhee CN. Acanthamoeba keratitis: a comprehensive photographic reference of common and uncommon signs. Clin Experiment Ophthalmol 2009; 37: 232-238
• 14 Papathanassiou M, Gartry D. Sterile corneal ulcer with ring infiltrate and hypopyon after recurrent erosions. Eye 2007; 21: 124-126
• 15 Thomas KE, Purcell TL, Tanzer DJ. et al. Delayed diagnosis of microsprodial stromal keratitis: unusual Wessely ring presentation and partial treatment with medications against Acanthamoeba. BMJ Case Rep 2011;
• 16 Kremer I, Cohen EJ, Eagle jr. RC. et al. Histopathologic evaluation of stromal inflammation in Acanthamoeba keratitis. CLAO J 1994; 20: 45-48
• 17 Clarke DW, Alizadeh H, Niederkorn JY. Failure of Acanthamoeba castellanii to produce intraocular infections. Invest Ophthalmol Vis Sci 2005; 46: 2472-2478
• 18 Shigeyasu C, Shimazaki J. Ocular surface reconstruction after exposure to high concentrations of antiseptic solutions. Cornea 2012; 31: 59-65
• 19 Awwad ST, Heilman M, Hogan RN. et al. Severe reactive ischemic posterior segment inflammation in acanthamoeba keratitis: a new potentially blinding syndrome. Ophthalmology 2007; 114: 313-320
• 20 Herz NL, Matoba AY, Wilhelmus KR. Rapidly progressive cataract and iris atrophy during treatment of Acanthamoeba keratitis. Ophthalmology 2008; 115: 866-869
• 21 Kelley PS, Dossey AP, Patel D. et al. Secondary glaucoma associated with advanced acanthamoeba keratitis. Eye Contact Lens 2006; 32: 178-182
• 22 Ehlers N, Hjordtal J. Are cataract and iris atrophy toxic complications of medical treatment of acanthamoeba keratitis?. Acta Ophthalmol Scand 2004; 82: 228-231
• 23 Iovieno A, Gore DM, Carnt N. et al. Acanthamoeba sclerokeratitis: epidemiology, clinical features and treatment outcomes. Ophthalmology 2014; 121: 2340-2347
• 24 Larkin DF, Kilvington S, Dart JK. Treatment of Acanthamoeba keratitis with polyhexamethylene biguanide. Ophthalmology 1992; 99: 185-191
• 25 Ficker L, Seal D, Warhurst D. et al. Acanthamoeba keratitis – resistance to medical therapy. Eye (Lond) 1990; 4 (Pt 6): 835-838
• 26 Wright P, Warhurst D, Jones BR. Acanthamoeba keratitis successfully treated medically. Br J Ophthalmol 1985; 69: 778-782
• 27 Elder MJ, Kilvington S, Dart JK. A clinicopathologic study of in vitro sensitivity testing and Acanthamoeba keratitis. Invest Ophthalmol Vis Sci 1994; 35: 1059-1064
• 28 Sunada A, Kimura K, Nishi K. et al. In vitro evaluations of topical agents to treat acanthamoeba keratitis. Ophthalmology 2014; 121: 2059-2065
• 29 Polat ZA, Walochnik J, Obwaller A. et al. Miltefosine and polyhexamethylene biguanide: a new drug combination for the treatment of Acanthamoeba keratitis. Clin Exp Ophthalmol 2014; 42: 151-158
• 30 McClellan K, Howard K, Niederkorn JY. et al. Effect of steroids on Acanthamoeba cysts and trophozoites. Invest Ophthalmol Vis Sci 2001; 42: 2885-2893
• 31 Carnt N, Optom B, Robaei D. et al. The impact of topical corticosteroids used in conjunction with antiamoebic therapy on the outcome of acanthamoeba keratitis. Ophthalmology 2016; 123: 984-990
• 32 DʼAversa G, Stern GA, Driebe jr. WT. Diagnosis and successful medical treatment of Acanthamoeba keratitis. Arch Ophthalmol 1995; 113: 1120-1123
• 33 Amoils SP, Heney C. Acanthamoeba keratitis with live isolates treated with cryosurgery and fluconazole. Am J Ophthalmol 1999; 127: 718-720
• 34 Oldenburg CE, Acharya NR, Tu EZ. et al. Practice patterns and opinions in the treatment of acanthamoeba keratitis. Cornea 2011; 30: 1363-1368
• 35 Sunada A, Kimura K, Nishi K. et al. In vitro evaluations of topical agents to treat acanthamoeba keratitis. Ophthalmology 2014; 121: 2059-2065
• 36 Brooks Jr JG, Coster DJ, Badenoch PR. Acanthamoeba keratitis. Resolution after epithelial debridement. Cornea 1994; 13: 186-189
• 37 Klüppel M, Reinhard T, Sundmacher R. et al. Therapie der fortgeschrittenen Amöbenkeratitis mit Keratoplastik à chaud und adjuvanter Kryoapplikation. Ophthalmologe 1997; 94: 99-103
• 38 Seitz B, Resch MD, Schlötzer-Schrehardt U. et al. Histopathology and ultrastructure of human corneas after amniotic membrane transplantation. Arch Ophthalmol 2006; 124: 1487-1490
• 39 Szentmáry N, Goebels S, Bischoff M. et al. Photodynamische Therapie (PDT) bei infektiöser Keratitis. Ophthalmologe 2012; 109: 165-170
• 40 Khan YA, Kashiwabuchi RT, Martins SA. et al. Riboflavin and ultraviolet light a therapy as an adjuvant treatment for medically refractive Acanthamoeben keratitis: report of 3 cases. Ophthalmology 2011; 118: 324-331
• 41 Laurik KL, Szentmáry N, Daas L. et al. Penetrating keratoplasty à chaud in acute acanthamoeba keratitis. ARVO Abstract 2016.
• 42 Hager T, Hasenfus A, Stachon T. et al. Crosslinking and corneal cryotherapy in acanthamoeba keratitis – a histological study. Graefes Arch Clin Exp Ophthalmol 2016; 254: 149-153
• 43 Seitz B, Langenbucher A, Kus MM. et al. Nonmechanical corneal trephination with the excimer laser improves outcome after penetrating keratoplasty. Ophthalmology 1999; 106: 1556-1564
• 44 Szentmáry N, Langenbucher A, Kus MM. et al. Elliptical nonmechanical corneal trephination – Intraoperative complications and long-term outcome of 42 consecutive penetrating keratoplasties. Cornea 2007; 26: 414-420
• 45 Robaei D, Carnt N, Minassian DC. et al. Therapeutic and optical keratoplasty in the management of Acanthamoeba keratitis: risk factors, outcomes, and summary of the literature. Ophthalmology 2015; 122: 17-24
• 46 Szentmáry N, Daas L, Matoula P. et al. Akanthamöbenkeratitis. Ophthalmologe 2013; 110: 1203-1210