Ausgeprägter Wessely-Immunring bei Keratitis – ein Chamäleon

Weinstein, Isabel; Fries, Fabian N.; Szentmáry, Nóra; Seitz, Berthold; Daas, Loay

doi:10.1007/s00347-020-01084-8

Cited by 5 publications

(3 citation statements)

References 6 publications

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“…It must be emphasized that the presence of stromal ring-shaped infiltrates is not exclusively associated with Acanthamoeba infection. It is also commonly seen in other infectious and non-infectious agents, namely HSV and the chronic wearing of CLs, respectively [9], as seen in our case.…”

Section: Discussionsupporting

confidence: 71%

Atypical Presentation of Herpes Stromal Keratitis in a Contact Lens Wearer

Subramaniam¹,

Teo²,

Muhammed³

2023

Cureus

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This article describes the case of a 21-year-old female habitual contact lens wearer who complained of left eye pain, redness, and decreased vision for one week. When a ring-shaped corneal infiltration indicative of an Acanthamoeba infection was discovered, standard anti-amoebic topical therapy with polyhexamethylene biguanide and chlorhexidine was commenced. However, her keratitis worsened. At the same time, corneal scraping revealed no pathogens. An anterior chamber examination revealed a loss of corneal sensation, and a positive herpes simplex virus (HSV) immunoglobulin G serology test indicated HSV keratitis. She was eventually treated with oral anti-viral medication and recovered completely. Her case was unusual, as she had a history of contact lens use, painful corneal ulceration, and the development of Acanthamoeba keratitis-like corneal ring infiltration. This case also reinforces the various manifestations of HSV keratitis, which lead to delayed diagnosis and treatment.

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Section: Discussionsupporting

confidence: 71%

Atypical Presentation of Herpes Stromal Keratitis in a Contact Lens Wearer

Subramaniam¹,

Teo²,

Muhammed³

2023

Cureus

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“…While the ring infiltrate or Wessely's immune ring (Fig. 5) sometimes is regarded as almost pathognomonic [22], it is important to note that it is a nonspecific finding that can occur in infectious keratitis of various origin as well as non-infectious etiology and thus can be also misleading In the PCR group, all cases were initially misdiagnosed, mostly as bacterial keratitis (88.2%) [23]. Our data show that a ring infiltrate is rather seen in advanced stages [20,24,25].…”

Section: Clinical Findings and Initial Diagnosismentioning

confidence: 99%

Impact of implementation of polymerase chain reaction on diagnosis, treatment, and clinical course of Acanthamoeba keratitis

Roth

Balasiu

Daas

et al. 2023

Graefes Arch Clin Exp Ophthalmol

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Purpose Acanthamoeba keratitis (AK) is a painful and possibly sight-threatening ocular infection. While the correct diagnosis and specific treatment in the early stages significantly improve the prognosis, the disease is often misdiagnosed and in clinical examination confused with other forms of keratitis. Polymerase chain reaction (PCR) for the detection of AK was first introduced in our institution in December 2013 to improve the timely diagnosis of AK. The aim of this study was to assess the impact of implementation of Acanthamoeba PCR on the diagnosis and treatment of the disease in a German tertiary referral center. Patients and methods Patients treated for Acanthamoeba keratitis between 1st of January 1993 and 31st of December 2021 in the Department of Ophthalmology of the University Hospital Duesseldorf were identified retrospectively via in-house registries. Evaluated parameters include age, sex, initial diagnosis, method of correct diagnosis, duration of symptoms until correct diagnosis, contact lens use, visual acuity, and clinical findings as well as medical and surgical therapy by keratoplasty (pKP). In order to assess the impact of implementation of Acanthamoeba PCR, the cases were divided into two groups (before (pre-PCR group) and after PCR implementation (PCR group). Results Seventy-five patients with Acanthamoeba keratitis were included (69.3% female, median age 37 years). Eighty-four percent (63/75) of all patients were contact lens wearers. Until PCR was available, 58 patients with Acanthamoeba keratitis were diagnosed either clinically (n = 28), by histology (n = 21), culture (n = 6), or confocal microscopy (n = 2) with a median duration until diagnosis of 68 (18; 109) days. After PCR implementation, in 17 patients, the diagnosis was established with PCR in 94% (n = 16) and median duration until diagnosis was significantly shorter with 15 (10; 30.5) days. A longer duration until correct diagnosis correlated with a worse initial visual acuity (p = 0.0019, r = 0.363). The number of pKP performed was significantly lower in the PCR group (5/17; 29.4%) than in the pre-PCR group (35/58; 60.3%) (p = 0.025). Conclusions The choice of diagnostic method and especially the application of PCR have a significant impact on the time to diagnosis and on the clinical findings at the time of confirmation of diagnosis and the need for penetrating keratoplasty. In contact lens–associated keratitis, the first crucial step is to take AK into consideration and perform a PCR test as timely confirmation of diagnosis of AK is imperative to prevent long-term ocular morbidity.

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“…Since 1981 the number of cases has increased gradually and more than 100 cases have been reported in the United States in recent years. 5 In Great Britain, about 400 cases of Acanthamoeba keratitis have been reported since 1977, but the real incidence of Acanthamoeba keratitis is unknown. 6 More than 750 cases have been diagnosed worldwide.…”

Section: Brief Reviewmentioning

confidence: 99%

Current Trends in Treating Acanthamoeba Keratitis: A Brief Narrative Review

Salducci

2020

pak J Ophthalmol

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The Author, after examining the historical evolution of scientific knowledge and treatment of severe Acanthamoebic keratitis, presents this brief review on the treatment of this serious eye disease, relatively frequent in patients with corneal contact lenses. Therapy of Acanthamoeba keratitis is always very long and demanding. Its management requires adequate experience because it is not always easy to evaluate the response to treatment and complications can be very serious and difficult to manage. Resistance to therapy can also occur during treatment and must be distinguished from drug-induced toxicity. In cases where no improvement is obtained with maximum medical therapy, it is advisable to repeat the corneal sampling and proceed to new laboratory tests for Acanthamoeba, bacteria and fungi. Prevention, which always remains of fundamental importance, is practically based on avoiding contact of the corneal lens with contaminated water, since this Acanthamoeba has a ubiquitous diffusion. It is therefore recommended to always avoid the use of corneal contact lenses in the pool or in the shower, not to wash them under running tap water and to frequently replace the relative container of these lenses. Key Words: Acanthamoeba Keratitis, Corneal ulcer, Contact lenses.

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Ausgeprägter Wessely-Immunring bei Keratitis – ein Chamäleon

Cited by 5 publications

References 6 publications

Atypical Presentation of Herpes Stromal Keratitis in a Contact Lens Wearer

Atypical Presentation of Herpes Stromal Keratitis in a Contact Lens Wearer

Impact of implementation of polymerase chain reaction on diagnosis, treatment, and clinical course of Acanthamoeba keratitis

Current Trends in Treating Acanthamoeba Keratitis: A Brief Narrative Review

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