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Berger T, Seitz B, Flockerzi F, Daas L. Recurrent Filamentous Fungal Keratitis Caused When the Primarily Selected Graft Diameter was Too Small. Klin Monbl Augenheilkd 2023; 240:1098-1102. [PMID: 35320860 DOI: 10.1055/a-1756-5147] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE To establish the importance of using a sufficiently large corneal graft in primary penetrating keratoplasty in order to prevent recurrence of fungal keratitis. OBERSERVATIONS A 58-year-old female patient underwent emergency penetrating keratoplasty (diameter 7.0 mm, double running suture) for therapy-resistant fungal keratitis (Fusarium solani) at an external eye clinic. Despite intensive antifungal therapy, new fungal infiltrates appeared in the host cornea after a few days. The patient was referred to our department for further treatment. On first presentation, circular infiltrates were seen around the corneal graft with anterior chamber involvement and therapy-resistant hypopyon. We performed an emergency penetrating repeat keratoplasty (diameter of 13.0 mm, 32 interrupted sutures) combined with anterior chamber lavage and intracameral and intrastromal drug injection. CONCLUSION AND IMPORTANCE Fungal keratitis sometimes has a frustrating clinical course. Therefore, early diagnosis with effective therapy initiation is of the utmost importance. In cases of penetrating keratoplasty, optimal planning and timing (before anterior chamber involvement) should be provided. Sufficient safety distance must be ensured in the choice of graft diameter, fixation with multiple interrupted sutures, and anterior chamber lavage, as well as intracameral and intrastromal drug administration. Incomplete excision carries a risk of recurrence and endophthalmitis in the course. Close postoperative control is necessary to detect early recurrences.
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Affiliation(s)
- Tim Berger
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Germany
| | - Berthold Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Germany
| | - Fidelis Flockerzi
- Institut für Allgemeine und Spezielle Pathologie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Germany
| | - Loay Daas
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Germany
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Large-Diameter Penetrating Keratoplasties are Mostly Due to Very Severe Infectious Keratitis and Cannot Always Prevent Secondary Enucleation. Klin Monbl Augenheilkd 2021; 239:1361-1368. [PMID: 33853185 DOI: 10.1055/a-1396-4787] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To report the indications and outcomes of penetrating keratoplasties with a graft diameter > 8.5 mm in severe corneal diseases at the Department of Ophthalmology at Saarland University Medical Centre. STUDY DESIGN Retrospective (6 years), descriptive, and observational. METHODS Thirty-five large-diameter penetrating keratoplasties (LDPKPs) in 27 patients (mean age, 62 ± 22 years) were performed from March 2010 to December 2016. The indication for surgery, number of previous corneal transplantations, best-corrected visual acuity (BCVA) before surgery, intraocular pressure, graft status, and BCVA at last follow-up were recorded. RESULTS Infectious keratitis represented 83% of the indications (of those, 45% fungal). The mean corneal graft diameter was 10.8 ± 1.7 (min 8.75, max 15.0) mm. Twenty-three eyes (65% absolute) had at least one previous penetrating keratoplasty (mean graft size, 9.2 ± 1.6 mm). The mean pre-surgery BCVA was 1.96 ± 0.23 logMAR. With a mean follow-up period of 20.2 ± 13.4 months, the mean BCVA was 1.57 ± 0.57 logMAR at last follow-up. Overall, 12 grafts (35%) remained clear until the last follow-up, and in 23 grafts (65%), the primary disease recurred, or corneal decompensation developed. Up to the last follow-up, 6 eyes (17%) had to be enucleated. CONCLUSIONS In complex cases of infectious keratitis requiring a LDPKP to remove the complete pathology and preserve eye integrity, the visual outcomes are generally expected to be poor, not only because of the well-known risks of LDPKP but also because of the consequences of the infectious disease itself. This knowledge is important for adequate counselling of the patient preoperatively.
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Szentmáry N, Shi L, Daas L, Seitz B. Diagnostics and management approaches for Acanthamoeba keratitis. Expert Opin Orphan Drugs 2020. [DOI: 10.1080/21678707.2020.1791081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Nóra Szentmáry
- Dr. Rolf M. Schwiete Center for Limbal Stem Cell and Aniridia Research, Saarland University, Homburg/Saar, Germany
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Lei Shi
- Department of Ophthalmology, Saarland University Medical Center, UKS, Homburg/Saar, Germany
| | - Loay Daas
- Department of Ophthalmology, Saarland University Medical Center, UKS, Homburg/Saar, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center, UKS, Homburg/Saar, Germany
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Shi L, Stachon T, Latta L, Elhawy MI, Gunaratnam G, Orosz E, Kiderlen AF, Seitz B, Bischoff M, Szentmáry N. Comparison of in vitro assays to study the effectiveness of antiparasitics against Acanthamoeba castellani trophozoites and cysts. Acta Microbiol Immunol Hung 2019; 67:23-32. [PMID: 31833381 DOI: 10.1556/030.66.2019.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 07/12/2019] [Indexed: 12/11/2022]
Abstract
We aimed to compare LDH release assay, trypan blue and fluorescent stainings, and non-nutrient Escherichia coli plate assay in determining treatment efficacy of antiamoebic agents against Acanthamoeba castellanii trophozoites/cysts, in vitro. 1BU trophozoites/cysts were challenged with 0.02% polyhexamethylene biguanid (PHMB), 0.1% propamidine isethionate (PD), and 0.0065% miltefosine (MF). Efficacies of the drugs were determined by LDH release and trypan blue assays, by Hoechst 33343, calcein-AM, and ethidium homodimer-1 fluorescent dyes, and by a non-nutrient agar E. coli plate assay. All three antiamoebic agents induced a significant LDH release from trophozoites, compared to controls (p < 0.0001). Fluorescent-dye staining in untreated 1BU trophozoites/cysts was negligible, but using antiamoebic agents, there was 59.3%-100% trypan blue, 100% Hoechst 33342, 0%-75.3% calcein-AM, and 100% ethidium homodimer-1 positivity. On E. coli plates, in controls and MF-treated 1BU trophozoites/cysts, new trophozoites appeared within 24 h, encystment occurred after 5 weeks. In PHMB- and PD-treated 1BU throphozoites/cysts, irregularly shaped, smaller trophozoites appeared after 72 h, which failed to form new cysts within 5 weeks. None of the enzymatic- and dye-based viability assays tested here generated survival rates for trophozoites/cysts that were comparable with those yielded with the non-nutrient agar E. coli plate assay, suggesting that the culture-based assay is the best method to study the treatment efficacy of drugs against Acanthamoeba.
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Affiliation(s)
- Lei Shi
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, P. R. China
| | - Tanja Stachon
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Lorenz Latta
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Mohamed Ibrahem Elhawy
- Institute for Medical Microbiology and Hygiene, Saarland University, Homburg/Saar, Germany
| | - Gubesh Gunaratnam
- Institute for Medical Microbiology and Hygiene, Saarland University, Homburg/Saar, Germany
| | - Erika Orosz
- Department of Parasitology, National Public Health Center, Budapest, Hungary
| | | | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Markus Bischoff
- Institute for Medical Microbiology and Hygiene, Saarland University, Homburg/Saar, Germany
| | - Nóra Szentmáry
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
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Orosz E, Kriskó D, Shi L, Sándor GL, Kiss HJ, Seitz B, Nagy ZZ, Szentmáry N. Clinical course of Acanthamoeba keratitis by genotypes T4 and T8 in Hungary. Acta Microbiol Immunol Hung 2019; 66:289-300. [PMID: 30835133 DOI: 10.1556/030.66.2019.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Genus Acanthamoeba is an opportunistic protozoan that is widely distributed in the environment. Within this genus, numerous species are recognized as human pathogens, potentially causing Acanthamoeba keratitis (AK). AK is a corneal disease, associated predominantly with contact lens (CL) wear; its epidemiology is related to the specific Acanthamoeba genotypes. This study reports seven CL wearer, Acanthamoeba PCR-positive patients with AK, diagnosed between January 2015 and 2018. Patients had the diagnosis of AK 1.36 months after first symptoms. Genotyping allowed the identification of six isolates of the T4 and one of the T8 genotypes. At first presentation, pseudendritiformic epithelopathy/dirty epithelium (four eyes, 57.1%), multifocal stromal infiltrates (five eyes, 71.4%), ring infiltrate (three eyes, 42.8%), and perineuritis (one eye, 14.3%) were observed. AK was healed without later recurrence in two eyes (28.5%) using triple-topical therapy, in three eyes (42.8%) following additional penetrating keratoplasty. In one patient (14.3%), AK recurred following successful application of triple-therapy and was treated successfully with repeated triple-topical therapy and in one patient (14.3%), no follow-up data were available after diagnosis. We could not observe correlation of genotype and clinical course or the necessity of corneal transplantation in our case series.
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Affiliation(s)
- Erika Orosz
- 1 Department of Parasitology, National Public Health Center, Budapest, Hungary
| | - Dorottya Kriskó
- 2 Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Lei Shi
- 3 Department of Ophthalmology, Saarland University Medical Center, Homburg, Germany
| | - Gábor L. Sándor
- 2 Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Huba J. Kiss
- 2 Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Berthold Seitz
- 3 Department of Ophthalmology, Saarland University Medical Center, Homburg, Germany
| | - Zoltán Zsolt Nagy
- 2 Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Nóra Szentmáry
- 2 Department of Ophthalmology, Semmelweis University, Budapest, Hungary
- 3 Department of Ophthalmology, Saarland University Medical Center, Homburg, Germany
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Laurik KL, Szentmáry N, Daas L, Langenbucher A, Seitz B. Early Penetrating Keratoplasty À Chaud May Improve Outcome in Therapy-Resistant Acanthamoeba Keratitis. Adv Ther 2019; 36:2528-2540. [PMID: 31317392 DOI: 10.1007/s12325-019-01031-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Long-standing acanthamoeba keratitis (AK) may result in corneal neovascularization, extension of the infiltrate to the limbus or sclera, broad peripheral synechiae, mature cataract or ischemic posterior segment inflammation. We investigated the impact of early emergency penetrating keratoplasty (PKP) in therapy-resistant cases among the patients of a highly specialized tertiary care center. METHODS In this retrospective, observational cohort within a single institution, we collected data on best-corrected visual acuity (BCVA), epithelial wound healing, graft survival and secondary complications of AK patients who underwent PKP. A total of 23 eyes of 23 patients diagnosed with acute, therapy-resistant AK between 2006 and 2015 were enrolled. Postoperative combined topical treatment was tapered for 6-9 months. RESULTS Eyes were grouped based on preoperative disease duration as shorter (group 1) or longer (group 2) than the median. The median was 5.3 (0.66-36) months. The BCVA in group 1 (20/44 ± 20/18; 0.32 ± 0.18 logMAR) was significantly better than in group 2 (20/1200 ± 20/1133; 1.28 ± 0.89; logMAR); p = 0.015. Persisting epithelial defects occurred in 5 patients (50%) of group 1 and in 10 patients (77%) of group 2. In 5 eyes (group 2), no epithelial healing could be achieved. After 36 months, graft survival (Kaplan-Meier) was 78% (18 grafts) for all patients (90% in group 1 and 44% in group 2). CONCLUSION PKP à chaud within 5.3 months after first symptoms of therapy-resistant AK seems to result in better final BCVA than delayed graft surgery if the disease is resistant to a classical topical triple therapy. In addition, early PKP may have a favorable impact on epithelial healing and graft survival. FUNDING We thank the Alexander von Humboldt Foundation for supporting the work of Prof. N. Szentmáry at the Department of Ophthalmology of Saarland University Medical Center in Homburg/Saar, Germany. We thank the University of Saarland for funding the medical writing assistance and the Rapid Service Fees. The funding organisation had no role in the design or conduct of this research.
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Shi L, Stachon T, Seitz B, Wagenpfeil S, Langenbucher A, Szentmáry N. The Effect of Antiamoebic Agents on Viability, Proliferation and Migration of Human Epithelial Cells, Keratocytes and Endothelial Cells, In Vitro. Curr Eye Res 2018. [PMID: 29528760 DOI: 10.1080/02713683.2018.1447674] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE To analyze the effect of diamidines (hexamidine-diisethionat (HD), propamidin-isethionate (PD), dibromopropamidine-diisethionat (DD)), and biguanides (polyhexamethylen biguanid (PHMB), chlorhexidine (CH)) on human corneal epithelial cell, keratocyte and endothelial cell viability, proliferation, and migration, in vitro. METHODS For epithelial and endothelial cells a human cell line and for keratocytes primary cultures were used (n = 6 each). We used 3.9x10-4-0.1% HD, PD or DD, 3.9x10-4-0.0125% PD, 7.8x10-5-0.02% PHMB or CH concentration for 24 h to determine viability (Cell Proliferation Kit XTT), proliferation (Cell Proliferation ELISA BrdU kit), and migration using wound healing assay. Viability/proliferation/migration values of each drug were summarized as "area under curve" (AUC) together with a Mann-Whitney test. RESULTS HCEC, keratocyte, and HCEC-12 viability AUC, comparing PD and PHMB (p ≤ 0.014 for all; PD better) or PD and HD (p ≤ 0.011 for all; PD better) differed significantly. Keratocyte and HCEC-12 viability AUC comparing CH and HD (p ≤ 0.027; CH better), HCEC-12 viability AUC comparing PD and HD (p = 0.005; PD better) and HCEC viability AUC comparing CH and PHMB (p = 0.014; CH better) differed significantly. HCEC proliferation AUC, comparing PD with PHMB, CH, DD, HD (p ≤ 0.016; PD worse for all) and keratocyte proliferation AUC, comparing PHMB with HD, PD (p = 0.004; p = 0.002; PHMB better for both), CH with HD, PD (p ≤ 0.001; CH better for both) and DD with PD (p = 0.043; DD better) differed significantly. Keratocyte migration AUC comparing PD with control, PHMB, CH, DD and HD differed significantly (p ≤ 0.012; PD worse for all). CONCLUSIONS Propamidin-isethionate as diamidine and chlorhexidin as biguanide may be used clinically to reduce cytotoxicity of antiamoebic treatment on human corneal cells. Diamidines reduce proliferation of human epithelial cells and keratocytes more than biguanides and propamidin-isethionate reduces migration of keratocytes. Therefore, in spite of lower cytotoxicity, the inhibitory effect on proliferation and migration indicates that extended use of propamidin-isethionate should be avoided in patients.
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Affiliation(s)
- Lei Shi
- a Department of Ophthalmology , Saarland University Medical Center , Homburg , Saar , Germany.,b Department of Ophthalmology , Anhui Provincial Hospital , Hefei , China
| | - Tanja Stachon
- a Department of Ophthalmology , Saarland University Medical Center , Homburg , Saar , Germany
| | - Berthold Seitz
- a Department of Ophthalmology , Saarland University Medical Center , Homburg , Saar , Germany
| | - Stefan Wagenpfeil
- c Institute of Medical Biometry, Epidemiology and Medical Informatics , Saarland University Medical Center , Homburg , Saar , Germany
| | - Achim Langenbucher
- d Institute of Experimental Ophthalmology , Saarland University , Homburg , Saar , Germany
| | - Nóra Szentmáry
- a Department of Ophthalmology , Saarland University Medical Center , Homburg , Saar , Germany.,e Department of Ophthalmology , Semmelweis University , Budapest , Hungary
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Daas L, Viestenz A, Schnabel PA, Fries FN, Hager T, SzentmÁry N, Seitz B. Confocal microscopy as an early relapse marker for acanthamoeba
keratitis. Clin Anat 2017; 31:60-63. [DOI: 10.1002/ca.22925] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 05/22/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Loay Daas
- Department of Ophthalmology; Saarland University Medical Center UKS; Homburg/Saar Germany
| | - Arne Viestenz
- Department of Ophthalmology; Saarland University Medical Center UKS; Homburg/Saar Germany
- Department of Ophthalmology; UKH, Martin- Luther-University Halle-Wittenberg; Halle Germany
| | | | - Fabian N. Fries
- Department of Ophthalmology; Saarland University Medical Center UKS; Homburg/Saar Germany
| | - Tobias Hager
- Department of Ophthalmology; Saarland University Medical Center UKS; Homburg/Saar Germany
| | - Nora SzentmÁry
- Department of Ophthalmology; Saarland University Medical Center UKS; Homburg/Saar Germany
- Department of Ophthalmology; Semmelweis University; Budapest Hungary
| | - Berthold Seitz
- Department of Ophthalmology; Saarland University Medical Center UKS; Homburg/Saar Germany
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Daas L, Szentmáry N, Eppig T, Langenbucher A, Hasenfus A, Roth M, Saeger M, Nölle B, Lippmann B, Böhringer D, Reinhard T, Kelbsch C, Messmer E, Pleyer U, Roters S, Zhivov A, Engelmann K, Schrecker J, Zumhagen L, Thieme H, Darawsha R, Meyer-Ter-Vehn T, Dick B, Görsch I, Hermel M, Kohlhaas M, Seitz B. [The German Acanthamoeba keratitis register: Initial results of a multicenter study]. Ophthalmologe 2016; 112:752-63. [PMID: 25833754 DOI: 10.1007/s00347-014-3225-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND PURPOSE In September 2011 the cornea section of the German Ophthalmological Society (DOG) established the first German Acanthamoeba keratitis registry. The data of this multicenter survey are being collected, compiled and evaluated at the Department of Ophthalmology at the Saarland University. The aim of this article is to present an intermediate report. PATIENTS AND METHODS Data from 172 eyes with Acanthamoeba keratitis were collected during the last 10 years. For this interim report we actually evaluated 121 eyes (60.2 % female patients, average age 41.3 years) and collected the following data: date of onset of symptoms, date and method of diagnosis, initial diagnosis, anamnestic data, clinical symptoms and signs at diagnosis and during follow-up, conservative and surgical therapy. Criteria for inclusion in the Acanthamoeba registry was the established diagnosis of an Acanthamoeba keratitis with at least one of the methods described in this article. RESULTS Acanthamoeba keratitis could be histologically proven in 55.3 % of the cases, via PCR in 25.6 %, with confocal microscopy in 20.4 % and using in vitro cultivation in 15.5 %. Clinical symptoms and signs in Acanthamoeba keratitis were pain in 67.0 %, ring infiltrates in 53.4 %, pseudodendritiform epitheliopathy in 11.7 % and keratoneuritis in 5.8 %. In 47.6 % of the cases the initial diagnosis was herpes simplex virus keratitis followed by bacterial keratitis in 25.2 % and fungal keratitis in 3.9 %. Acanthamoeba keratitis was the correct initial diagnosis in only 23.2 % of cases. The average time period between first symptoms and diagnosis was 2.8 ± 4.0 months (range 0-23 months). A triple therapy with Brolene® Lavasept® and antibiotic eye drops at least 5 ×/day was used in 54.5 % of eyes (n = 66). Penetrating keratoplasty was performed in 40.4 %, in 18 cases in combination with cryotherapy of the cornea. The mean graft diameter was 7.9 ± 1.1 mm (range 3.5-11.0 mm). The final visual acuity (Snellen visual acuity chart at 5 m) was comparable in the two groups of eyes with (5/40 ± 5/25) and without (5/32 ± 5/25) keratoplasty. CONCLUSION Acanthamoeba keratitis is a rare and often very late diagnosed disease and two thirds of the cases were initially misdiagnosed. The early recognition of the typical symptoms is crucial for the prognosis of the disease. All ophthalmological departments in Germany are invited to submit further data of all confirmed cases (berthold.seitz@uks.eu), whether retrospectively or prospectively in order to generate an adequate standardized diagnostic and therapeutic approach for this potentially devastating disease.
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Affiliation(s)
- L Daas
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrbergerstr. 100, 66424, Homburg/Saar, Deutschland.
| | - N Szentmáry
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrbergerstr. 100, 66424, Homburg/Saar, Deutschland
| | - T Eppig
- Experimentelle Ophthalmologie, Universität des Saarlandes, Homburg/Saar, Deutschland
| | - A Langenbucher
- Experimentelle Ophthalmologie, Universität des Saarlandes, Homburg/Saar, Deutschland
| | - A Hasenfus
- Institut für Allgemeine und spezielle Pathologie, Universität des Saarlandes, Homburg/Saar, Deutschland
| | - M Roth
- Universitätsaugenklinik, Düsseldorf, Deutschland
| | - M Saeger
- Klinik für Ophthalmologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - B Nölle
- Klinik für Ophthalmologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - B Lippmann
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - D Böhringer
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - T Reinhard
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - C Kelbsch
- Universitätsaugenklinik, Tübingen, Deutschland
| | - E Messmer
- Augenklinik der LMU, München, Deutschland
| | - U Pleyer
- Universitätsaugenklinik, Berlin Charité, Berlin, Deutschland
| | - S Roters
- Universitätsaugenklinik, Köln, Deutschland
| | - A Zhivov
- Universitätsaugenklinik, Rostock, Deutschland
| | | | | | - L Zumhagen
- Universitätsaugenklinik, Münster, Deutschland
| | - H Thieme
- Universitätsaugenklinik, Magdeburg, Deutschland
| | - R Darawsha
- Universitätsaugenklinik, Essen, Deutschland
| | | | - B Dick
- Universitätsaugenklinik, Bochum, Deutschland
| | - I Görsch
- Universitätsaugenklinik, Hamburg-Eppendorf, Deutschland
| | - M Hermel
- Universitätsaugenklinik, Aachen, Deutschland
| | - M Kohlhaas
- Augenklinik Dortmund, Dortmund, Deutschland
| | - B Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrbergerstr. 100, 66424, Homburg/Saar, Deutschland
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The role of domestic tap water on Acanthamoeba keratitis in non-contact lens wearers and validation of laboratory methods. Parasitol Res 2015; 114:3283-9. [DOI: 10.1007/s00436-015-4549-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 05/19/2015] [Indexed: 10/23/2022]
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