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Zilles M, Flockerzi E, Daas L, Weinstein I, Hamon L, Seitz B. Impact of cleanroom status on the reasons for discarding organ-cultured corneal transplants in a modern eye bank - More donor corneas thanks to astronaut suit? Acta Ophthalmol 2024; 102:e672-e678. [PMID: 38131522 DOI: 10.1111/aos.16611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 11/10/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE This study investigated the influence of cleanroom conditions on the discard rates of donor corneas in a German university eye bank. METHODS Discard rates were analysed from 2017 to 2020 at the LIONS Cornea Bank at Saarland University Medical Center. 1941 corneas from 971 donors were included. 1262 corneas (65.1%) were stored in a class D cleanroom from 2017 to 2019 and processed in a cleanroom class A sterile bank (group 1). 679 corneas (34.9%) were continuously stored in a class B cleanroom and processed in a class A cleanroom safety cabinet in the same room from 2019 to 2020 (group 2). The target parameter of this work was the number of contamination-related discards. Although they cannot be influenced by the spatial conditions, the discards due to insufficient endothelial quality, serology, contraindications, scars and technical causes were also recorded. Statistical analysis was performed using SPSS and various testing procedures. RESULTS In group 1, significantly more corneas were discarded due to positive serology (6.9%|3.8%, p = 0.020). There was no significant change between both groups for either contamination or the other reasons for discard. CONCLUSION Optimization of hygiene standards from cleanroom class D to B did not reduce contamination. Serology, endothelial quality, medical contraindications and the presence of scars cannot be influenced by cleanroom conditions.
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Affiliation(s)
- Marco Zilles
- Department of Ophthalmology, University Hospital of the Saarland (UKS), Homburg, Germany
| | - Elias Flockerzi
- Department of Ophthalmology, University Hospital of the Saarland (UKS), Homburg, Germany
| | - Loay Daas
- Department of Ophthalmology, University Hospital of the Saarland (UKS), Homburg, Germany
| | - Isabel Weinstein
- Department of Ophthalmology, University Hospital of the Saarland (UKS), Homburg, Germany
| | - Loic Hamon
- Department of Ophthalmology, University Hospital of the Saarland (UKS), Homburg, Germany
| | - Berthold Seitz
- Department of Ophthalmology, University Hospital of the Saarland (UKS), Homburg, Germany
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2
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Blaser F, Bajka A, Grimm F, Metzler S, Herrmann D, Barthelmes D, Zweifel SA, Said S. Assessing PCR-Positive Acanthamoeba Keratitis-A Retrospective Chart Review. Microorganisms 2024; 12:1214. [PMID: 38930596 PMCID: PMC11205950 DOI: 10.3390/microorganisms12061214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 06/04/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
Ophthalmologists' diagnostic and treatment competence in Acanthamoeba keratitis varies widely. This investigator-initiated, retrospective, single-center chart review examined the electronic patient files regarding PCR-positive Acanthamoeba keratitis. We included corneal and contact lens assessments. We further reviewed the patient's medical history, corneal scraping results regarding viral or fungal co-infections, and the duration from symptom onset to final diagnosis. We identified 59 eyes of 52 patients from February 2010 to February 2023, with 31 of 52 (59.6%) being female patients. The median (IQR, range) patient age was 33 (25.3 to 45.5 [13 to 90]) years, and the mean (SD, range) time to diagnosis after symptom onset was 18 (10.5 to 35 [3 to 70]) days. Overall, 7 of 52 (7.7%) patients displayed a bilateral Acanthamoeba infection, and 48 (92.3%) used contact lenses at symptom onset. Regarding other microbiological co-infections, we found virologic PCR testing in 45 of 52 (86.5%) patients, with 3 (6.7%) positive corneal scrapings. Fungal cultures were performed in 49 of 52 (94.2%) patients, with 5 (10.2%) positive corneal scrapings. The medical treatment success rate was 45/46 (97.8%). This study raises awareness of patient education in contact lens handling and screens for further microbial co-infections in suspected Acanthamoeba cases.
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Affiliation(s)
- Frank Blaser
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland (S.S.)
| | - Anahita Bajka
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland (S.S.)
| | - Felix Grimm
- Institute of Parasitology, University of Zurich, 8057 Zurich, Switzerland
| | - Simone Metzler
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland (S.S.)
| | - Didier Herrmann
- Institute of Optometry, University of Applied Science, 4600 Olten, Switzerland
| | - Daniel Barthelmes
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland (S.S.)
| | - Sandrine Anne Zweifel
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland (S.S.)
| | - Sadiq Said
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland (S.S.)
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3
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Abu Dail Y, Daas L, Flockerzi FA, Seitz B. [Bilateral chronic contact lens-associated keratitis]. DIE OPHTHALMOLOGIE 2024; 121:410-414. [PMID: 38315191 DOI: 10.1007/s00347-024-01993-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 12/27/2023] [Accepted: 01/17/2024] [Indexed: 02/07/2024]
Affiliation(s)
- Y Abu Dail
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 100, Gebäude 22, 66421, Homburg/Saar, Deutschland.
| | - L Daas
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 100, Gebäude 22, 66421, Homburg/Saar, Deutschland
| | - F A Flockerzi
- Institut für Pathologie, Universitätsklinikum des Saarlandes UKS, Homburg/Saar, Deutschland
| | - B Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 100, Gebäude 22, 66421, Homburg/Saar, Deutschland
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da Silveira J, Cardoso AP, Fernandes C, Junior AH, da Rosa Monte Machado G, Caumo KS. Anti-Acanthamoeba metallopharmaceuticals: Amoebicidal activity and synergistic effect of copper(II) coordination compound. Biometals 2024:10.1007/s10534-024-00602-4. [PMID: 38647983 DOI: 10.1007/s10534-024-00602-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 03/30/2024] [Indexed: 04/25/2024]
Abstract
Acanthamoeba spp. emerged as a clinically important pathogen related to amoebic keratitis. It is among the main causes of corneal transplantation and vision loss in ophthalmology. The treatment protocols have a low cure rate, high toxicity, and need for drug combination. Transition metal compounds have shown promising antiprotozoal effects. This study evaluates the amoebicidal activity of copper(II) coordination compounds in combination with chlorhexidine and the cytotoxicity to topical ocular application. These copper(II) coordination compounds were screened against Acanthamoeba castellanii trophozoites (ATCC 50492). The cytotoxicity on rabbit corneal cell line (ATCC-CCL 60) was performed. The compounds showed high amoebicidal potential, with inhibition of trophozoite viability above 80%. The Cp12 and Cp13 compounds showed Minimal Inhibitory Amoebicidal Concentration (MIAC) at 200 µM and mean inhibitory concentration (IC50) values lower than 10 µM. Against the cysts, Cp12 showed a reduction in viability (48%) in the longest incubation period. A synergistic effect for Cp12 with chlorhexidine was observed. The compounds have a dose-dependent effect against rabbit corneal cells. Compound Cp12 has potential for future application in developing ophthalmic formulations against Acanthamoeba keratitis and its use in multipurpose solutions is highlighted.
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Affiliation(s)
- Jaqueline da Silveira
- Departamento de Análises Clínicas, Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Laboratório de Investigação Aplicada a Protozoários Emergentes (LADIPE), Florianópolis, Santa Catarina, 88040-970, Brazil
| | - Ana Paula Cardoso
- Departamento de Química, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, 88040-900, Brazil
| | - Christiane Fernandes
- Departamento de Química, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, 88040-900, Brazil
| | - Adolfo Horn Junior
- Departamento de Química, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, 88040-900, Brazil
| | - Gabriella da Rosa Monte Machado
- Departamento de Análises Clínicas, Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Laboratório de Investigação Aplicada a Protozoários Emergentes (LADIPE), Florianópolis, Santa Catarina, 88040-970, Brazil
| | - Karin Silva Caumo
- Departamento de Análises Clínicas, Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Laboratório de Investigação Aplicada a Protozoários Emergentes (LADIPE), Florianópolis, Santa Catarina, 88040-970, Brazil.
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Petrillo F, Tortori A, Vallino V, Galdiero M, Fea AM, De Sanctis U, Reibaldi M. Understanding Acanthamoeba Keratitis: An In-Depth Review of a Sight-Threatening Eye Infection. Microorganisms 2024; 12:758. [PMID: 38674702 PMCID: PMC11052265 DOI: 10.3390/microorganisms12040758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/02/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024] Open
Abstract
Acanthamoeba keratitis (AK) is a rare but potentially sight-threatening corneal infection caused by the Acanthamoeba parasite. This microorganism is found ubiquitously in the environment, often in freshwater, soil, and other sources of moisture. Despite its low incidence, AK presents significant challenges due to delayed diagnosis and the complex nature of therapeutic management. Early recognition is crucial to prevent severe ocular complications, including corneal ulceration and vision loss. Diagnostic modalities and treatment strategies may vary greatly depending on the clinical manifestation and the available tools. With the growing reported cases of Acanthamoeba keratitis, it is essential for the ophthalmic community to thoroughly understand this condition for its effective management and improved outcomes. This review provides a comprehensive overview of AK, encompassing its epidemiology, risk factors, pathophysiology, clinical manifestations, diagnosis, and treatment.
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Affiliation(s)
- Francesco Petrillo
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (V.V.); (A.M.F.); (U.D.S.); (M.R.)
- Department of Ophthalmology, “City of Health and Science” Hospital, 10126 Turin, Italy
| | - Antonia Tortori
- Ophthalmology Unit, Surgery Department, Piacenza Hospital, 29121 Piacenza, Italy;
| | - Veronica Vallino
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (V.V.); (A.M.F.); (U.D.S.); (M.R.)
- Department of Ophthalmology, “City of Health and Science” Hospital, 10126 Turin, Italy
| | - Marilena Galdiero
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 81100 Naples, Italy;
| | - Antonio M. Fea
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (V.V.); (A.M.F.); (U.D.S.); (M.R.)
- Department of Ophthalmology, “City of Health and Science” Hospital, 10126 Turin, Italy
| | - Ugo De Sanctis
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (V.V.); (A.M.F.); (U.D.S.); (M.R.)
- Department of Ophthalmology, “City of Health and Science” Hospital, 10126 Turin, Italy
| | - Michele Reibaldi
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (V.V.); (A.M.F.); (U.D.S.); (M.R.)
- Department of Ophthalmology, “City of Health and Science” Hospital, 10126 Turin, Italy
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6
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Przybek-Skrzypecka J, Walkden A, Brahma A, Chidambaram J, Carley FM. Impact of First Healthcare Provider on Acanthamoeba Keratitis Course: How to Overcome Poor Prognosis in Acanthamoeba Keratitis Treatment? A Single Tertiary Center, Observational Study. Clin Ophthalmol 2023; 17:3975-3982. [PMID: 38146454 PMCID: PMC10749575 DOI: 10.2147/opth.s438990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/07/2023] [Indexed: 12/27/2023] Open
Abstract
Background To assess the difference in course and final visual outcome of Acanthamoeba keratitis (AK) patients based on the first healthcare provider (HCP) seen. Methods Retrospective observational cohort study of AK patients admitted to the Manchester Royal Eye Hospital between 2003 and 2017. HCPs were grouped (Group 1: Optometrists, Opticians; Group 2: General Practitioners (GPs); Group 3: Ophthalmologists) and the data analyzed on demographics, risk factors, clinical history, clinical features, and Acanthamoeba subspecies. Results Forty-one patients with unilateral culture-proven AK were included. Median time to consultation with first HCP was 7 days (IQR 4-14 days), while mean time to the correct diagnosis of AK was 15 days (IQR 7-29 days). Patients saw an optician, optometrist or ophthalmologists significantly earlier than GPs (median 4 days, vs 15 or 5 days, respectively, p = 0.04). Bacterial keratitis was the most common initial clinical diagnosis (43%). The shortest time to making the AK diagnosis (median 11 days) and the highest rate of initiating AK treatment started at the first visit (38%) were both in the ophthalmologists' group. No significant differences were observed in initial and final visual acuity between HCP groups (p = 0.36). Conclusion AK patients often seek ocular help earlier from optometrists and opticians than medical doctors. Final clinical outcomes did not significantly differ based on the first HCP seen, but ophthalmologists were more likely to make the diagnosis of AK and initiate anti-amoebal therapy faster than other HCPs. Greater education and collaboration between ophthalmologists and other HCPs to increase awareness of AK are needed.
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Affiliation(s)
- Joanna Przybek-Skrzypecka
- Department of Ophthalmology, Medical University of Warsaw, Warsaw, Poland
- SPKSO Ophthalmic University Hospital, Warsaw, Poland
| | - Andrew Walkden
- Cornea Department, Manchester Royal Eye Hospital, Manchester University NHS Foundation, Manchester, UK
- School of Biological Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Arun Brahma
- Cornea Department, Manchester Royal Eye Hospital, Manchester University NHS Foundation, Manchester, UK
| | - Jaya Chidambaram
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Fiona M Carley
- Cornea Department, Manchester Royal Eye Hospital, Manchester University NHS Foundation, Manchester, UK
- School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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7
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Kim MJ, Jo HJ, Sohn HJ, Shin HJ, Quan FS, Kong HH, Moon EK. Evaluating the Diagnostic Potential of Chorismate Mutase Poly-Clonal Peptide Antibody for the Acanthamoeba Keratitis in an Animal Model. Pathogens 2023; 12:pathogens12040526. [PMID: 37111412 PMCID: PMC10145577 DOI: 10.3390/pathogens12040526] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/17/2023] [Accepted: 03/24/2023] [Indexed: 03/31/2023] Open
Abstract
Acanthamoeba spp. is the causative agent of Acanthamoeba keratitis (AK), a vision-threatening parasitic disease whose primary risk factor has been attributed to poor contact lens hygiene. Unfortunately, differential diagnosis of AK is challenging as the clinical manifestations for AK are similar to those of bacterial, fungal, or even viral keratitis. Since delayed AK diagnosis can incur permanent vision impairment, a rapid and sensitive diagnostic method is urgently needed. Here, the diagnostic potential of polyclonal antibodies targeting the chorismate mutase (CM) of Acanthamoeba spp. was evaluated in AK animal models. CM antibody specificity against Acanthamoeba trophozoites and cysts was confirmed by immunocytochemistry after co-culturing Acanthamoeba with Fusarium solani, Pseudomonas aeruginosa, and Staphylococcus aureus, and human corneal epithelial (HCE) cells. Enzyme-linked immunosorbent assay (ELISA) was performed using CM-specific immune sera raised in rabbits, which demonstrated that the antibodies specifically interacted with the Acanthamoeba trophozoites and cysts in a dose-dependent manner. To evaluate the diagnostic potential of the CM antibody, AK animal models were established by incubating contact lenses with an inoculum containing A. castellanii trophozoites and subsequently overlaying these lenses onto the corneas of BALB/c mice for 7 and 21 days. The CM antibody specifically detected Acanthamoeba antigens in the murine lacrimal and eyeball tissue lysates at both time points. Our findings underscore the importance of antibody-based AK diagnosis, which could enable early and differential AK diagnosis in clinical settings.
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Affiliation(s)
- Min-Jeong Kim
- Department of Biomedical Science, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Hye-Jeong Jo
- Department of Biomedical Science, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Hae-Jin Sohn
- Department of Microbiology, Ajou University School of Medicine, Suwon 16499, Republic of Korea
| | - Ho-Joon Shin
- Department of Microbiology, Ajou University School of Medicine, Suwon 16499, Republic of Korea
| | - Fu-Shi Quan
- Department of Medical Zoology, School of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
- Medical Research Center for Bioreaction to Reactive Oxygen Species and Biomedical Science Institute, Core Research Institute (CRI), Kyung Hee University, Seoul 02447, Republic of Korea
| | - Hyun-Hee Kong
- Department of Parasitology, Dong-A University College of Medicine, Busan 49201, Republic of Korea
| | - Eun-Kyung Moon
- Department of Medical Zoology, School of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
- Correspondence:
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Pastrana C, Guerreiro JRL, Elumalai M, Carpena-Torres C, Crooke A, Carracedo G, Prado M, Huete-Toral F. Dual-Mode Gold Nanoparticle-Based Method for Early Detection of Acanthamoeba. Int J Mol Sci 2022; 23:ijms232314877. [PMID: 36499204 PMCID: PMC9740238 DOI: 10.3390/ijms232314877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/23/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022] Open
Abstract
Acanthamoeba keratitis is an aggressive and rapidly progressing ocular pathology whose main risk factor is the use of contact lenses. An early and differential diagnosis is considered the main factor to prevent the progression and improve the prognosis of the pathology. However, current diagnosis techniques require time, complex and costly materials making an early diagnosis challenging. Thus, there is a need for fast, accessible, and accurate methods for Acanthamoeba detection by practitioners for timely and suitable treatment and even for contact lens user as preventive diagnosis. Here, we developed a dual-mode colorimetric-based method for fast, visual, and accurate detection of Acanthamoeba using gold nanoparticles (AuNPs). For this strategy, AuNPs were functionalized with thiolated probes and the presence of target Acanthamoeba genomic sequences, produce a colorimetric change from red to purple. This approach allows the detection of 0.02 and 0.009 μM of the unamplified Acanthamoeba genome by the naked eye in less than 20 min and by color analysis using a smartphone. Additionally, real samples were successfully analyzed showing the potential of the technology considering the lack of point-of-care tools that are mostly needed.
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Affiliation(s)
- Cristina Pastrana
- Ocupharm Research Group, Department of Optometry and Vision, Faculty of Optics and Optometry, Complutense University of Madrid, C/Arcos de Jalón 118, 28037 Madrid, Spain
- Correspondence: (C.P.); (J.R.L.G.)
| | - J. Rafaela L. Guerreiro
- Food Quality and Safety Group, International Iberian Nanotechnology Laboratory (INL), Av. Mestre José Veiga, 4715-330 Braga, Portugal
- BioMark@ISEP, School of Engineering of the Polytechnic Institute of Porto, Rua Dr. António Bernardino de Almeida 431, 4249-015 Porto, Portugal
- CEB/LABBELS, Center of Biological Engineering, Minho University, Campus de Gualtar, Rua da Universidade, 4710-057 Braga, Portugal
- Correspondence: (C.P.); (J.R.L.G.)
| | - Monisha Elumalai
- Food Quality and Safety Group, International Iberian Nanotechnology Laboratory (INL), Av. Mestre José Veiga, 4715-330 Braga, Portugal
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907, USA
| | - Carlos Carpena-Torres
- Ocupharm Research Group, Department of Optometry and Vision, Faculty of Optics and Optometry, Complutense University of Madrid, C/Arcos de Jalón 118, 28037 Madrid, Spain
| | - Almudena Crooke
- Department of Biochemistry and Molecular Biology, Faculty of Optics and Optometry, Complutense University of Madrid, C/Arcos de Jalón 118, 28037 Madrid, Spain
| | - Gonzalo Carracedo
- Ocupharm Research Group, Department of Optometry and Vision, Faculty of Optics and Optometry, Complutense University of Madrid, C/Arcos de Jalón 118, 28037 Madrid, Spain
| | - Marta Prado
- Food Quality and Safety Group, International Iberian Nanotechnology Laboratory (INL), Av. Mestre José Veiga, 4715-330 Braga, Portugal
| | - Fernando Huete-Toral
- Ocupharm Research Group, Department of Optometry and Vision, Faculty of Optics and Optometry, Complutense University of Madrid, C/Arcos de Jalón 118, 28037 Madrid, Spain
- Department of Biochemistry and Molecular Biology, Faculty of Optics and Optometry, Complutense University of Madrid, C/Arcos de Jalón 118, 28037 Madrid, Spain
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Maier P, Kammrath Betancor P, Reinhard T. Contact Lens-Associated Keratitis-an Often Underestimated Risk. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:669-674. [PMID: 35912449 PMCID: PMC9830382 DOI: 10.3238/arztebl.m2022.0281] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 04/19/2022] [Accepted: 07/07/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Millions of people in Germany wear contact lenses every day. Deficient contact lens hygiene can lead to corneal infection. Contact lens-associated keratitis usually has a highly acute presentation and can cause long-term visual loss. METHODS This review is based on pertinent publications retrieved by a selective search in PubMed, as well as on relevant metaanalyses, Cochrane reviews, and reports by national and international health care authorities. RESULTS 23-94% of contact lens wearers report associated discomfort and eye problems. The annual incidence of contact lens-associated keratitis is 2-4/10 000. It is due to bacteria in 90% of cases, and much less commonly to acanthamoebae and fungi. The pathogens generally arrive with the contact lens on the surface of the eye and can penetrate into the corneal tissue because the tear film under the lens is not swept away from the ocular surface by the eyelids, and corneal epithelial changes are often present as well. Corneal infiltration that is diagnosed early is often self-limited, but advanced bacterial infection usually requires intense topical antibiotic treatment. Some severe infections can only be eradicated by emergency corneal transplantation; this is the case in 20-30 % of fungal and acanthamoebic infections. CONCLUSION The wearing of contact lenses, particularly soft ones, is associated with a risk of microbial keratitis if proper contact lens hygiene is not exercised. Contact lens-associated keratitis very rarely causes permanent damage to eyesight (0.6 cases per 10 000 contact lens wearers per year). The use of contact lenses always calls for meticulous care.
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Affiliation(s)
- Philip Maier
- Eye Center, Medical Center, University of Freiburg,*Klinik für Augenheilkunde Universitätsklinikum Freiburg Killianstr. 5 79106 Freiburg, Germany
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10
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Ward MS, Hastings JP, Shmunes KM, Ronquillo Y, Hoopes PC, Moshirfar M. Atypical presentation of acanthamoeba keratitis resembling central toxic keratopathy. Am J Ophthalmol Case Rep 2022; 25:101243. [PMID: 35028488 PMCID: PMC8715135 DOI: 10.1016/j.ajoc.2021.101243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 08/25/2021] [Accepted: 12/13/2021] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To describe an atypical case of acanthamoeba keratitis with positive in vivo confocal microscopy in a non-contact lens user who presented with signs and symptoms suggestive of central toxic keratopathy. OBSERVATIONS The patient presented with bilateral, though sequential, decreased visual acuity with mild pain. Examination showed stromal haze with corneal flattening and thinning without epithelial defects. Optical coherence tonometry of the right eye revealed an inverse dome-shaped appearance of the opacity and in-vivo confocal imaging showed double-walled cysts consistent with acanthamoeba. Corneal haze, stromal loss, resolved and visual acuity improved over time. CONCLUSION AND IMPORTANCE Acanthamoeba is a rare cause of infectious keratitis that is most often associated with contact lens wear in developed countries. Typically, it presents with a unilateral decrease in visual acuity, photophobia, watering, and pain that is out of proportion to slit lamp examination findings. However, many atypical presentations have been reported in the literature. Consequently, it may be misdiagnosed, especially early in the course of the disease. This delay in diagnosis can lead to progressive ulceration and visual impairment. In addition, cyst formation can make eradication with anti-amoebic treatment especially difficult.Central toxic keratopathy is a non-inflammatory clinical syndrome of unknown etiology that is most often associated with excimer laser ablation, though other associated causes have been reported. It is characterized by a central or paracentral opacity with corneal stromal loss and resultant hyperopic shift. The opacification and stromal loss mostly resolve over the course of months with an improvement in visual acuity. This report may help physicians broaden their differential and correctly diagnose atypical presentations of amoebic infection.
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Affiliation(s)
| | - Jordan P. Hastings
- California Northstate University College of Medicine, Elk Grove, CA, USA
| | | | | | | | - Majid Moshirfar
- Hoopes Vision Research Center, Draper, UT, USA
- John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA
- Utah Lions Eye Bank, Murray, UT, USA
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11
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Farah CJ, Seitz B, Hamon L, Sourlis C, Daas L. [Coinfections in contact lens-associated mycotic keratitis with Pseudomonas or Acanthamoeba]. Ophthalmologe 2021; 118:940-943. [PMID: 32821967 PMCID: PMC8413168 DOI: 10.1007/s00347-020-01207-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Kontaktlinsenassoziierte Keratitiden werden immer häufiger. Die mykotische Keratitis ist ein relativ seltenes, aber sehr ernst zu nehmendes Krankheitsbild. Meist wird im Frühstadium eine falsche Diagnose gestellt und dadurch die adäquate Therapie verzögert. Bei der therapierefraktären kontaktlinsenassoziierten mykotischen Keratitis können nicht selten auch Koinfektionen oder Superinfektionen bestehen. Wir stellen 2 Patienten mit initial unklarer Keratitis vor, bei denen eine Mischinfektion der mykotischen Keratitis mit Pseudomonas aeruginosa bzw. Akanthamöben nachgewiesen werden konnte. In beiden Fällen war die zeitnahe perforierende Excimerlaser-Keratoplastik mit Einzelknüpfnähten und adäquater Lokaltherapie über 8 Wochen therapeutisch erfolgreich.
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Affiliation(s)
- C J Farah
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 100, Gebäude 22, 66421, Homburg/Saar, Deutschland.
| | - B Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 100, Gebäude 22, 66421, Homburg/Saar, Deutschland
| | - L Hamon
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 100, Gebäude 22, 66421, Homburg/Saar, Deutschland
| | - C Sourlis
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 100, Gebäude 22, 66421, Homburg/Saar, Deutschland
| | - L Daas
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 100, Gebäude 22, 66421, Homburg/Saar, Deutschland
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Negative Corneal Fluorescein Staining as an Exceptionally Early Sign of Acanthamoeba Keratitis: A Case Report. Eye Contact Lens 2021; 47:622-624. [PMID: 34348354 DOI: 10.1097/icl.0000000000000825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To report the negative fluorescein staining as an early sign of Acanthamoeba keratitis (AK). METHODS Case report and brief review of related literature. REPORT OF CASE A 30-year-old, contact lens wearer, woman presented with mild irritation and pain in the right eye. The best-corrected visual acuity (BCVA) was 20/20 in both eyes. Slit-lamp examination revealed a peripheral corneal infiltration. Empirical antimicrobial therapy was initiated. Within the third day, peripheral corneal opacity regressed but a Y-shaped linear epitheliopathy with a negative fluorescein staining, because of a ridge-like epithelial irregularity, was observed in the central cornea. Clinical findings progressed rapidly. Confocal microscopy revealed hyper-reflective cysts with the typical double-ring sign consistent with AK. Therefore, topical chlorhexidine and propamidine were initiated. Clinical findings regressed subsequently. The final BCVA was 20/20 in both eyes. CONCLUSION Acanthamoeba keratitis usually manifest as superficial epitheliopathy and progresses to the stroma. Findings may be obscure or atypical; comprehensive and careful examination may reveal mild findings in the early stages.
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Brockmann T, Walckling M, Brockmann C, Fuchsluger TMA, Pleyer U. [Corneal wound healing-Pathophysiology and principles]. Ophthalmologe 2021; 118:1167-1177. [PMID: 34106316 DOI: 10.1007/s00347-021-01423-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2021] [Indexed: 01/09/2023]
Abstract
The cornea forms the anterior border of the eye and significantly contributes to a sharp optical image quality on the retina through its transparency, avascular nature and curvature. Because of its anatomical structure and as a barrier to the environment, the cornea is particularly exposed to various external factors, such as injuries and pathogens. A correct wound healing without the formation of light diverging scarring is therefore essential to preserve the integrity and function of the cornea. Misguided wound healing is of outstanding clinical relevance and can lead to corneal fibrogenesis. Corneal fibrosis results in scarring with a loss of optical transparency, which significantly reduces eyesight and can lead to blindness. Understanding the pathophysiological mechanisms of wound healing and fibrogenesis is of great importance for the diagnostics, treatment and evaluation of the subsequent healing process in order to prevent permanent damage as far as possible.
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Affiliation(s)
- Tobias Brockmann
- Klinik und Poliklinik für Augenheilkunde, Universitätsmedizin Rostock, Doberaner Straße 140, 18057, Rostock, Deutschland.
| | - Marcus Walckling
- Klinik und Poliklinik für Augenheilkunde, Universitätsmedizin Rostock, Doberaner Straße 140, 18057, Rostock, Deutschland
| | - Claudia Brockmann
- Klinik und Poliklinik für Augenheilkunde, Universitätsmedizin Rostock, Doberaner Straße 140, 18057, Rostock, Deutschland
| | - Tho Mas A Fuchsluger
- Klinik und Poliklinik für Augenheilkunde, Universitätsmedizin Rostock, Doberaner Straße 140, 18057, Rostock, Deutschland
| | - Uwe Pleyer
- Klinik und Poliklinik für Augenheilkunde, Charité - Universitätsmedizin Berlin, Berlin Institute of Health, Freie Universität Berlin, Humboldt-Universität zu Berlin, Augustenburger Platz 1, Berlin, 13353, Deutschland
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Challenges in Acanthamoeba Keratitis: A Review. J Clin Med 2021; 10:jcm10050942. [PMID: 33804353 PMCID: PMC7957573 DOI: 10.3390/jcm10050942] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 02/07/2023] Open
Abstract
To review challenges in the diagnosis and management of Acanthamoeba keratitis (AK), along with prognostic factors, in order to help ophthalmologists avoid misdiagnosis, protracted treatment periods, and long-term negative sequelae, with an overarching goal of improving patient outcomes and quality of life, we examined AK studies published between January 1998 and December 2019. All manuscripts describing clinical manifestations, diagnosis, treatment, prognosis, and challenges in short- and long-term management were included. The diagnosis of AK is often challenging. An increased time between symptom onset and the initiation of appropriate therapy is associated with poorer visual outcomes. The timely initiation of standardized antiamoebic therapies improves visual outcomes, decreases the duration of treatment, and reduces the chances of needing surgical intervention. In clinical practice, AK diagnosis is often missed or delayed, leading to poorer final visual outcomes and a negative impact on patient morbidity and quality of life.
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Detection and Identification of Acanthamoeba and Other Nonviral Causes of Infectious Keratitis in Corneal Scrapings by Real-Time PCR and Next-Generation Sequencing-Based 16S-18S Gene Analysis. J Clin Microbiol 2021; 59:JCM.02224-20. [PMID: 33239372 PMCID: PMC8111161 DOI: 10.1128/jcm.02224-20] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/16/2020] [Indexed: 01/29/2023] Open
Abstract
Acanthamoeba is a free-living amoeba of extensive genetic diversity. It may cause infectious keratitis (IK), which can also be caused by bacteria, fungi, and viruses. Acanthamoeba is a free-living amoeba of extensive genetic diversity. It may cause infectious keratitis (IK), which can also be caused by bacteria, fungi, and viruses. High diagnostic sensitivity is essential to establish an early diagnosis of Acanthamoeba-associated keratitis. Here, we investigated the applicability of next-generation sequencing (NGS)-based ribosomal gene detection and differentiation (16S-18S) compared with specific real-time PCR for the detection of Acanthamoeba. Two hundred DNAs extracted from corneal scrapings and screened by Acanthamoeba-specific real-time PCR were analyzed using an in-house 16S-18S NGS assay. Of these, 24 were positive by specific real-time PCR, of which 21 were positive by the NGS assay. Compared with real-time PCR; the specificity and sensitivity of the NGS assay were 100% and 88%, respectively. Genotypes identified by the NGS assay included T4 (n = 19) and T6 (n = 2). Fungal and bacterial species of potential clinical relevance were identified in 31 of the samples negative for Acanthamoeba, exemplified by Pseudomonas aeruginosa (n = 11), Moraxella spp. (n = 6), Staphylococcus aureus (n = 2), Fusarium spp. (n = 4), and Candida albicans (n = 1). In conclusion, the 16S-18S assay was slightly less sensitive than real-time PCR in detecting Acanthamoeba-specific DNA in corneal scrapings. Robust information on genotypes was provided by the NGS assay, and other pathogens of potential clinical relevance were identified in 16% of the samples negative for Acanthamoeba. NGS-based detection of ribosomal genes in corneal scrapings could be an efficient screening method for detecting nonviral causes of IK, including Acanthamoeba.
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Shi L, Muthukumar V, Stachon T, Latta L, Elhawy MI, Gunaratnam G, Orosz E, Seitz B, Kiderlen AF, Bischoff M, Szentmáry N. The Effect of Anti-Amoebic Agents and Ce6-PDT on Acanthamoeba castellanii Trophozoites and Cysts, In Vitro. Transl Vis Sci Technol 2020; 9:29. [PMID: 33262903 PMCID: PMC7691790 DOI: 10.1167/tvst.9.12.29] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 08/13/2020] [Indexed: 12/16/2022] Open
Abstract
Purpose The purpose of this study was to analyze the concentration-dependent effects of biguanides (polyhexamethylene biguanide [PHMB], chlorhexidine [CH]); diamidines (hexamidine-diisethionate [HD], propamidine-isethionate [PD], dibromopropamidine-diisethionate [DD]); natamycin (NM); miltefosine (MF); povidone iodine (PVPI), and chlorin e6 PDT on Acanthamoeba trophozoites and cysts, in vitro. Methods Strain 1BU was cultured in peptone-yeast extract-glucose medium. Trophozoites or cysts were cultured in PYG medium containing each agent at 100%, 50%, and 25% of maximum concentration for 2 hours. The percentage of dead trophozoites was determined using a non-radioactive cytotoxicity assay and trypan blue staining. Treated cysts were also maintained on non-nutrient agar Escherichia coli (E. coli) plates and observed for 3 weeks. Results All tested drugs displayed significant cytotoxic effects on 1BU cells based on the biochemical and staining-based viability assays tested. On non-nutrient agar E. coli plates, neither trophozoites nor freshly formed cysts were observed after PHMB, PD, NM, and PVPI treatment, respectively, within 3 weeks. However, CH-, HD-, DD-, and MF-treated cysts could excyst, multiply, and encyst again. Conclusions The off-label drugs PHMB, PD, NM, and PVPI are under in vitro conditions more effective against strain 1BU than CH, HD, DD, and MF. Our findings also suggest that the non-nutrient agar E. coli plate assay should be considered as method of choice for the in vitro analysis of the treatment efficacy of anti-amoebic agents. Translational Relevance Ophthalmologists may optimize the treatment regime against Acanthamoeba keratitis by pre-testing the in vitro susceptibilities of the Acanthamoeba strain against drugs of interest with the non-nutrient E. coli agar plate assay.
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Affiliation(s)
- Lei Shi
- Dr. Rolf M. Schwiete Center for Limbal Stem Cell and Aniridia Research, Saarland University, Homburg/Saar, Germany.,Department of Ophthalmology, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, People's Republic of China
| | - Vithusan Muthukumar
- Institute for Medical Microbiology and Hygiene, Saarland University, Homburg/Saar, Germany
| | - Tanja Stachon
- Dr. Rolf M. Schwiete Center for Limbal Stem Cell and Aniridia Research, Saarland University, Homburg/Saar, Germany
| | - Lorenz Latta
- Dr. Rolf M. Schwiete Center for Limbal Stem Cell and Aniridia Research, Saarland University, 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
- Dr. Rolf M. Schwiete Center for Limbal Stem Cell and Aniridia Research, Saarland University, Homburg/Saar, Germany.,Department of Ophthalmology, Semmelweis University, Budapest, Hungary
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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, Hager T, Fries FN, Daas L, Holbach L, Hofmann-Rummelt C, Zemova E, Seitz B, Szentmáry N. Reactive uveitis, retinal vasculitis and scleritis as ocular end-stage of Acanthamoeba keratitis: a histological study. Int J Ophthalmol 2019; 12:1966-1971. [PMID: 31850183 DOI: 10.18240/ijo.2019.12.20] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 08/21/2019] [Indexed: 11/23/2022] Open
Abstract
We analysed histologically two Acanthamoeba keratitis (AK) eyes with anterior and posterior segment inflammation and blindness. Two enucleated eyes of 2 patients (age 45 and 51y) with AK (PCR of epithelial abrasion positive) were analysed. Histological analysis was performed using hematoxylin-eosin, periodic acid-Schiff and Gömöri-methenamine silver staining. We could not observe Acanthamoeba trophozoites or cysts neither in the cornea nor in other ocular tissues. Meanwhile, we found uveitis, retinal vasculitis and scleritis in these eyes, due to the long-standing, recalcitrant AK. So in this stage of AK, systemic immune suppression may be necessary for a longer time period.
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Affiliation(s)
- Lei Shi
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar 66424, Germany.,Department of Ophthalmology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, Anhui Province, P.R. China
| | - Tobias Hager
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar 66424, Germany
| | - Fabian Norbert Fries
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar 66424, Germany
| | - Loay Daas
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar 66424, Germany
| | - Leonard Holbach
- Department of Ophthalmology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen 91052, Germany
| | - Carmen Hofmann-Rummelt
- Department of Ophthalmology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen 91052, Germany
| | - Elena Zemova
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar 66424, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar 66424, Germany
| | - Nóra Szentmáry
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar 66424, Germany.,Department of Ophthalmology, Semmelweis University, Budapest 1093, Hungary
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20
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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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Szentmáry N, Daas L, Shi L, Laurik KL, Lepper S, Milioti G, Seitz B. Acanthamoeba keratitis - Clinical signs, differential diagnosis and treatment. J Curr Ophthalmol 2019; 31:16-23. [PMID: 30899841 PMCID: PMC6407156 DOI: 10.1016/j.joco.2018.09.008] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/10/2018] [Accepted: 09/26/2018] [Indexed: 01/21/2023] Open
Abstract
PURPOSE To summarize actual literature data on clinical signs, differential diagnosis, and treatment of acanthamoeba keratitis. METHODS Review of literature. RESULTS Clinical signs of acanthamoeba keratitis are in early stages grey-dirty epithelium, pseudodendritiformic epitheliopathy, perineuritis, multifocal stromal infiltrates, ring infiltrate and in later stages scleritis, iris atrophy, anterior synechiae, secondary glaucoma, mature cataract, and chorioretinitis. As conservative treatment, we use up to one year triple-topical therapy (polyhexamethylene-biguanide, propamidine-isethionate, neomycin). In therapy resistant cases, surgical treatment options such as corneal cryotherapy, amniotic membrane transplantation, riboflavin-UVA cross-linking, and penetrating keratoplasty are applied. CONCLUSION With early diagnosis and conservative or surgical treatment, acanthamoeba keratitis heals in most cases.
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Affiliation(s)
- Nóra Szentmáry
- Department of Ophthalmology, Saarland University Medical Center, UKS, Homburg, Saar, Germany
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Loay Daas
- Department of Ophthalmology, Saarland University Medical Center, UKS, Homburg, Saar, Germany
| | - Lei Shi
- Department of Ophthalmology, Saarland University Medical Center, UKS, Homburg, Saar, Germany
| | - Kornelia Lenke Laurik
- Department of Ophthalmology, Saarland University Medical Center, UKS, Homburg, Saar, Germany
| | - Sabine Lepper
- Department of Ophthalmology, Saarland University Medical Center, UKS, Homburg, Saar, Germany
| | - Georgia Milioti
- 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, 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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26
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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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27
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[Good outcome in Acanthamoeba keratitis]. Ophthalmologe 2016; 114:653-655. [PMID: 27558689 DOI: 10.1007/s00347-016-0350-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
A 31-year-old woman presented with mild keratitis of her left eye. The use of daily disposable contact lenses, regularly rinsed with tap water, and the development of perineural corneal infiltrates resulted in the clinical suspicion of infection with Acanthamoeba. Corneal epithelial scraping probe for polymerase chain reaction on Acanthamoeba confirmed the clinical diagnosis. Although the treatment was limited to low-dose propamidine monotherapy because of reduced tolerability, the keratitis healed with almost no scarring after 13 months of consequent medication.
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Abstract
Fungal keratitis is a rare but very serious eye disease in industrial nations with a frequency of 1-5 % of all forms of keratitis from microbial causes. We present two patients with keratitis of primary unknown cause. Using confocal microscopy fungal filaments could be identified that partially showed a parallel configuration (like "railway tracks"). Thus, the correct diagnosis can often be made and suitable therapy can be non-invasively initiated even before the results of in vitro cultivation (fungal culture), polymerase chain reaction (PCR) and histological investigations are available.
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