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Akanthamöbenkeratitis

Acanthamoeba keratitis

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Zusammenfassung

Das typische Bild der Akanthamöbenkeratitis zeichnet sich durch pseudodendritiforme Epitheliopathie, Perineuritis, Ringinfiltrat oder multifokale stromale Infiltrate aus. Jedoch können auch eine Limbitis mit Infiltration der Konjunktiva oder eine Uveitis anterior auftreten. Etwa 83–93 % der Patienten mit Akanthamöbenkeratitis sind Kontaktlinsenträger. Die Diagnosestellung einer Akanthamöbeninfektion erfolgt anhand von Polymerasekettenreaktion (PCR), konfokaler Biomikroskopie, In-vitro-Kultivierung oder histopathologischen Untersuchungen. Bisher liegen keine randomisierten kontrollierten klinischen Studien vor, daher stammen die Informationen über Effektivität und Sicherheit der medikamentösen und chirurgischen Therapie nur aus publizierten Fallserien. Es wird eine 3-fache medikamentöse Therapie aus Polyhexamid, Propamidinisoethionat und Neomycin zur Behandlung empfohlen, die bis zu einem Jahr angewendet werden sollte. Bei Therapieresistenz kann eine Kryotherapie, Amnionmembrantransplantation, Crosslinkingtherapie oder eine therapeutische Keratoplastik notwendig werden. Bestanden 3 Monate lang vor einer geplanten Keratoplastik keine Infektionszeichen mehr, ist die Prognose am besten.

Abstract

The typical clinical appearance of acanthamoeba keratitis includes pseudodendritic epitheliopathy, perineuritis, ring infiltrates or multifocal stromal infiltrates and in some cases limbitis with infiltration of the conjunctiva and/or sterile anterior uveitis. In 83–93 % of cases of acanthamoeba keratitis the patients were contact lens wearers. Acanthamoeba keratitis is diagnosed by polymerase chain reaction (PCR), confocal biomicroscopy, in vitro cultivation and histopathological examination. Information on reliability and efficacy of conservative and surgical therapy of acanthamoeba keratitis has only been published in case series but not yet verified through randomized controlled clinical studies. After early diagnosis acanthamoeba keratitis can often be successfully treated using triple topical therapy with polyhexamide, propamidine isethionate and neomycin. Topical therapy should be continued for up to 1 year. In therapy-resistant cases cryotherapy, amniotic membrane transplantation, crosslinking therapy and therapeutic keratoplasty can be performed. The prognosis of keratoplasty following acanthamoeba keratitis is more favorable if there were no signs of infection at least 3 months before surgery.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. N. Szentmáry, L. Daas, P. Matoula, S. Goebels und B. Seitz geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes, UKS, Kirrberger Str. 100, 66424, Homburg/Saar, Deutschland

    N. Szentmáry, L. Daas, P. Matoula, S. Goebels & B. Seitz

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  1. N. Szentmáry
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  2. L. Daas
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  3. P. Matoula
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  4. S. Goebels
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  5. B. Seitz
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Correspondence to N. Szentmáry.

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Szentmáry, N., Daas, L., Matoula, P. et al. Akanthamöbenkeratitis. Ophthalmologe 110, 1203–1211 (2013). https://doi.org/10.1007/s00347-013-2981-0

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