title: [The German Acanthamoeba keratitis register: Initial results of a multicenter study].
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrbergerstr. 100, 66424, Homburg/Saar, Deutschland. loay.daas@uks.eu.
authors.forename: L
authors.initials: L
authors.lastname: Daas
authors.affiliation: Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrbergerstr. 100, 66424, Homburg/Saar, Deutschland.
authors.forename: N
authors.initials: N
authors.lastname: Szentmáry
authors.affiliation: Experimentelle Ophthalmologie, Universität des Saarlandes, Homburg/Saar, Deutschland.
authors.forename: T
authors.initials: T
authors.lastname: Eppig
authors.affiliation: Experimentelle Ophthalmologie, Universität des Saarlandes, Homburg/Saar, Deutschland.
authors.forename: A
authors.initials: A
authors.lastname: Langenbucher
authors.affiliation: Institut für Allgemeine und spezielle Pathologie, Universität des Saarlandes, Homburg/Saar, Deutschland.
authors.forename: A
authors.initials: A
authors.lastname: Hasenfus
authors.affiliation: Universitätsaugenklinik, Düsseldorf, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Roth
authors.affiliation: Klinik für Ophthalmologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Saeger
authors.affiliation: Klinik für Ophthalmologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland.
authors.forename: B
authors.initials: B
authors.lastname: Nölle
authors.affiliation: Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Freiburg, Deutschland.
authors.forename: B
authors.initials: B
authors.lastname: Lippmann
authors.affiliation: Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Freiburg, Deutschland.
authors.forename: D
authors.initials: D
authors.lastname: Böhringer
authors.affiliation: Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Freiburg, Deutschland.
authors.forename: T
authors.initials: T
authors.lastname: Reinhard
authors.affiliation: Universitätsaugenklinik, Tübingen, Deutschland.
authors.forename: C
authors.initials: C
authors.lastname: Kelbsch
authors.affiliation: Augenklinik der LMU, München, Deutschland.
authors.forename: E
authors.initials: E
authors.lastname: Messmer
authors.affiliation: Universitätsaugenklinik, Berlin Charité, Berlin, Deutschland.
authors.forename: U
authors.initials: U
authors.lastname: Pleyer
authors.affiliation: Universitätsaugenklinik, Köln, Deutschland.
authors.forename: S
authors.initials: S
authors.lastname: Roters
authors.affiliation: Universitätsaugenklinik, Rostock, Deutschland.
authors.forename: A
authors.initials: A
authors.lastname: Zhivov
authors.affiliation: Augenklinik Chemnitz, Chemnitz, Deutschland.
authors.forename: K
authors.initials: K
authors.lastname: Engelmann
authors.affiliation: KKH Rudolf Virchow, Glauchau, Deutschland.
authors.forename: J
authors.initials: J
authors.lastname: Schrecker
authors.affiliation: Universitätsaugenklinik, Münster, Deutschland.
authors.forename: L
authors.initials: L
authors.lastname: Zumhagen
authors.affiliation: Universitätsaugenklinik, Magdeburg, Deutschland.
authors.forename: H
authors.initials: H
authors.lastname: Thieme
authors.affiliation: Universitätsaugenklinik, Essen, Deutschland.
authors.forename: R
authors.initials: R
authors.lastname: Darawsha
authors.affiliation: Universitätsaugenklinik, Würzburg, Deutschland.
authors.forename: T
authors.initials: T
authors.lastname: Meyer-Ter-Vehn
authors.affiliation: Universitätsaugenklinik, Bochum, Deutschland.
authors.forename: B
authors.initials: B
authors.lastname: Dick
authors.affiliation: Universitätsaugenklinik, Hamburg-Eppendorf, Deutschland.
authors.forename: I
authors.initials: I
authors.lastname: Görsch
authors.affiliation: Universitätsaugenklinik, Aachen, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Hermel
authors.affiliation: Augenklinik Dortmund, Dortmund, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Kohlhaas
authors.affiliation: Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrbergerstr. 100, 66424, Homburg/Saar, Deutschland.
authors.forename: B
authors.initials: B
authors.lastname: Seitz
mesh_terms: D015823:Acanthamoeba Keratitis / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015948:Keratoplasty, Penetrating / Q000706:statistics & numerical data*; D008297:Male; D010865:Pilot Projects; D015995:Prevalence; D012042:Registries; D012307:Risk Factors; D063189:Symptom Assessment / Q000706:statistics & numerical data*; D016896:Treatment Outcome
keywords: Diagnosis; Multicenter study; Prognosis; Symptoms; Therapy
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