Akanthamöbenkeratitis: Wann ist der beste Zeitpunkt für eine Keratoplastik bei konservativer Therapieresistenz?

Zusammenfassung

Die Akanthamöbenkeratitis (AK) ist eine durch Akanthamöben hervorgerufene infektiöse Keratitis, die das Sehvermögen bedroht. Eine rechtzeitige und adäquate konservative Behandlung der AK kann zu einer Heilung der Keratitis mit guter Sehschärfe führen, ohne dass im weiteren Verlauf eine Keratoplastik erforderlich wird. Bei Therapieresistenz scheint die Keratoplastik nach intensiver Antiamöbentherapie (AAT), eine sog. „Low-Load-Keratoplastik“, eine bessere Gesamtprognose und eine frühere visuelle und psychologische Rehabilitation im Vergleich zur aktiv (= iatrogen) verzögerten Keratoplastik (optisch/therapeutisch) zu ermöglichen. Weitere Studien mit direktem Vergleich zwischen früher und später Keratoplastik sind notwendig, um den optimalen Zeitpunkt der Keratoplastik bei AK noch besser einzugrenzen.

Schlüsselwörter

Akanthamöbenkeratitis - konservative Therapie - Low-Load- Keratoplastik - optische Keratoplastik - therapeutische Keratoplastik

Publikationsverlauf

Eingereicht: 05. Dezember 2024

Angenommen: 11. März 2025

Artikel online veröffentlicht:
16. Juni 2025

• References/Literatur

• 1 Lorenzo-Morales J, Khan NA, Walochnik J. An update on Acanthamoeba keratitis: Diagnosis, pathogenesis and treatment. Parasite 2015; 22: 10
• 2 Nagington J, Watson PG, Playfair TJ. et al. Amoebic infection of the eye. Lancet 1974; 2: 1537-1540
• 3 Ting DSJ, Ho CS, Deshmukh R. et al. Infectious keratitis: An update on epidemiology, causative microorganisms, risk factors, and antimicrobial resistance. Eye (Lond) 2021; 35: 1084-1101
• 4 Nielsen SE, Ivarsen A, Hjortdal J. Increasing incidence of Acanthamoeba keratitis in a large tertiary ophthalmology department from year 1994 to 2018. Acta Ophthalmol 2020; 98: 445-448
• 5 Seal DV, Beattie TK, Tomlinson A. et al. Acanthamoeba keratitis. Br J Ophthalmol 2003; 87: 516
• 6 Roth M, Balasiu A, Daas L. et al. Impact of implementation of polymerase chain reaction on diagnosis, treatment, and clinical course of Acanthamoeba keratitis. Graefes Arch Clin Exp Ophthalmol 2023; 261: 1951-1959
• 7 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
• 8 List W, Glatz W, Riedl R. et al. Evaluation of Acanthamoeba keratitis cases in a tertiary medical care centre over 21 years. Sci Rep 2021; 11: 1036
• 9 Sarink MJ, Koelewijn R, Stelma F. et al. An international external quality assessment scheme to assess the diagnostic performance of polymerase chain reaction detection of Acanthamoeba keratitis. Cornea 2023; 42: 1027-1033
• 10 Vilares-Morgado R, Ferreira AM, Marques-Couto P. et al. Clinical outcomes and prognostic factors in Acanthamoeba keratitis. Cont Lens Anterior Eye 2024; 47: 102119
• 11 Shimmura-Tomita M, Takano H, Kinoshita N. et al. Risk factors and clinical signs of severe Acanthamoeba keratitis. Clin Ophthalmol 2018; 12: 2567-2573
• 12 Carnt N, Robaei D, Minassian DC. et al. Acanthamoeba keratitis in 194 patients: risk factors for bad outcomes and severe inflammatory complications. Br J Ophthalmol 2018; 102: 1431-1435
• 13 Alkharashi M, Lindsley K, Law HA. et al. Medical interventions for acanthamoeba keratitis. Cochrane Database Syst Rev 2015; (2015) CD010792
• 14 Szentmáry N, Daas L, Shi L. et al. Acanthamoeba keratitis – Clinical signs, differential diagnosis and treatment. J Curr Ophthalmol 2019; 31: 16-23
• 15 Kuennen RA, Smith RH, Mauger TF. et al. Enucleation following treatment with intravenous pentamidine for Acanthamoeba sclerokeratitis. Clin Ophthalmol 2010; 4: 1145
• 16 Shi L, Hager T, Fries FN. et al. Reactive uveitis, retinal vasculitis and scleritis as ocular end-stage of Acanthamoeba keratitis: a histological study. Int J Ophthalmol 2019; 12: 1966-1971
• 17 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
• 18 Daas L, Szentmáry N, Eppig T. et al. The German Acanthamoeba keratitis register: Initial results of a multicenter study. Ophthalmologe 2015; 112: 752-763
• 19 Wright P, Warhurst D, Jones BR. Acanthamoeba keratitis successfully treated medically. Br J Ophthalmol 1985; 69: 778-782
• 20 Awwad ST, Petroll WM, McCulley JP. et al. Updates in Acanthamoeba keratitis. Eye Contact Lens 2007; 33: 1-8
• 21 Kaufman AR, Tu EY. Advances in the management of Acanthamoeba keratitis: A review of the literature and synthesized algorithmic approach. Ocul Surf 2022; 25: 26-36
• 22 Dart JKG, Papa V, Rama P. et al. The Orphan Drug for Acanthamoeba Keratitis (ODAK) Trial: PHMB 0.08 % (polihexanide) and placebo versus PHMB 0.02 % and propamidine 0.1. Ophthalmology 2024; 131: 277-287
• 23 Fanselow N, Sirajuddin N, Yin XT. et al. Acanthamoeba keratitis, pathology, diagnosis and treatment. Pathogens 2021; 10: 1-11
• 24 Shing B, Balen M, McKerrow JH. et al. Acanthamoeba keratitis: An update on amebicidal and cysticidal drug screening methodologies and potential treatment with azole drugs. Expert Rev Anti Infect Ther 2021; 19: 1427-1441
• 25 Abu Dail Y, Flockerzi E, Munteanu C. et al. Rethinking keratoplasty for patients with Acanthamoeba keratitis: Early “low load keratoplasty” in contrast to late optical and therapeutic keratoplasty. Microorganisms 2024; 12: 1801
• 26 Heaselgrave W, Hamad A, Coles S. et al. In vitro evaluation of the inhibitory effect of topical ophthalmic agents on Acanthamoeba viability. Transl Vis Sci Technol 2019; 8: 17
• 27 Bagga B, Sharma S, Gour RPS. et al. A randomized masked pilot clinical trial to compare the efficacy of topical 1 % voriconazole ophthalmic solution as monotherapy with combination therapy of topical 0.02 % polyhexamethylene biguanide and 0.02 % chlorhexidine in the treatment of Acanthamoeba keratitis. Eye (Lond) 2021; 35: 1326-1333
• 28 Abu Dail Y, Daas L, Flockerzi FA. et al. [Bilateral chronic contact lens-associated keratitis]. Ophthalmologie 2024; 121: 410-414
• 29 Robaei D, Carnt N, Minassian DC. et al. The impact of topical corticosteroid use before diagnosis on the outcome of Acanthamoeba keratitis. Ophthalmology 2014; 121: 1383-1388
• 30 Scruggs BA, Quist TS, Zimmerman MB. et al. Risk factors, management, and outcomes of Acanthamoeba keratitis: A retrospective analysis of 110 cases. Am J Ophthalmol Case Rep 2022; 25: 101372
• 31 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
• 32 Lim N, Goh D, Bunce C. et al. Comparison of polyhexamethylene biguanide and chlorhexidine as monotherapy agents in the treatment of Acanthamoeba keratitis. Am J Ophthalmol 2008; 145: 130-135
• 33 Tu EY, Joslin CE, Sugar J. et al. Prognostic factors affecting visual outcome in Acanthamoeba keratitis. Ophthalmology 2008; 115: 1998-2003
• 34 Pérez-Samonja JJ, Kilvington S, Hughes R. et al. Persistently culture positive acanthamoeba keratitis: In vivo resistance and in vitro sensitivity. Ophthalmology 2003; 110: 1593-1600
• 35 Shi L, Muthukumar V, Stachon T. et al. The effect of anti-amoebic agents and Ce6-PDT on Acanthamoeba castellanii trophozoites and cysts, in vitro. Transl Vis Sci Technol 2020; 9: 29
• 36 Vontobel S, Abad-Villar EM, Kaufmann C. et al. Corneal penetration of polyhexamethylene biguanide and chlorhexidine digluconate. J Clin Exp Ophthalmol 2015; 6: 1000430
• 37 Hamburg A, De Jonckheere JF. Amoebic keratitis. Ophthalmologica 1980; 181: 74-80
• 38 Hirst LW, Green WR, Merz W. et al. Management of Acanthamoeba keratitis: a case report and review of the literature. Ophthalmology 1984; 91: 1105-1111
• 39 Awwad ST, Parmar DN, Heilman M. et al. Results of penetrating keratoplasty for visual rehabilitation after Acanthamoeba keratitis. Am J Ophthalmol 2005; 140: 1080-1084
• 40 Bacon AS, Frazer DG, Dart JKG. et al. A review of 72 consecutive cases of Acanthamoeba keratitis, 1984–1992. Eye (Lond) 1993; 7: 719-725
• 41 Kitzmann AS, Goins KM, Sutphin JE. et al. Keratoplasty for treatment of Acanthamoeba keratitis. Ophthalmology 2009; 116: 864-869
• 42 Alfaro Rangel R, Szentmáry N, Lepper S. et al. Large-diameter penetrating keratoplasties are mostly due to very severe infectious keratitis and cannot always prevent secondary enucleation. Klin Monbl Augenheilkd 2022; 239: 1361-1368
• 43 Seitz B, Langenbucher A, Naumann GOH. [The penetrating keratoplasty. A 100-year success story]. Ophthalmologe 2005; 102: 1128-1139
• 44 Papa V, van der Meulen I, Rottey S. et al. Safety and tolerability of topical polyhexamethylene biguanide: a randomised clinical trial in healthy adult volunteers. Br J Ophthalmol 2022; 106: 190-196
• 45 Zhang T, Xie L, Dong Y. et al. Therapeutic keratoplasty for severe Acanthamoeba keratitis: Risk factors, clinical features, and outcomes of postoperative recurrence. Graefes Arch Clin Exp Ophthalmol 2023; 261: 1299-1309
• 46 Kashiwabuchi RT, De Freitas D, Alvarenga LS. et al. Corneal graft survival after therapeutic keratoplasty for Acanthamoeba keratitis. Acta Ophthalmol 2008; 86: 666-669