Introduction With less than 3 new cases per million people,Acanthamoebakeratitis (AK)
is an orphan disease. It is a potentially devastating ocular infection without standardized
guidelines for diagnostics and treatment. Areas covered A comprehensive Pubmed and
Clinical Trial search has been performed to summarize current diagnostics and management
approaches for AK before March 2020. Ophthalmologists must recognize its clinical
signs, such as gray-dirty epithelium, pseudodendritiformic epitheliopathy, perineuritis,
multifocal stromal infiltrates, and ring infiltrate for a timely adequate treatment.
In later stages, scleritis, iris atrophy, anterior synechiae, secondary glaucoma,
mature cataract, and chrorioretinitis are referred to as classical clinical signs.
A clinical suspicion must be followed by laboratory diagnostics using confocal microscopy,
polymerase-chain-reaction (PCR), microbiological culture, and/or histopathological
examination. The first randomized clinical drug trial for the treatment of AK is planned
to be completed in 2021. Expert opinion Up to date, as conservative treatment up to
1 year, triple-topical therapy (polyhexamethilen-biguanide, propamidine-isethionate,
neomycin) and, in therapy-resistant cases, surgical treatment in form of corneal cryotherapy,
riboflavin-UVA crosslinking and penetrating keratoplasty is used. In our opinion,
a specific medical treatment should be clinically applied in the future, following
isolation of the pathognomicAcanthamoebastrain, and afterin vitroculturing and testing.
