Diagnosis of Acanthamoeba Keratitis: Past, Present and Future

Author:

Azzopardi Matthew1ORCID,Chong Yu Jeat2,Ng Benjamin2ORCID,Recchioni Alberto23ORCID,Logeswaran Abison4,Ting Darren S. J.235ORCID

Affiliation:

1. Department of Ophthalmology, Royal London Hospital, London E1 1BB, UK

2. Birmingham and Midland Eye Centre, Birmingham B18 7QH, UK

3. Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK

4. Moorfields Eye Hospital, London EC1V 2PD, UK

5. Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK

Abstract

Acanthamoeba keratitis (AK) is a painful and sight-threatening parasitic corneal infection. In recent years, the incidence of AK has increased. Timely and accurate diagnosis is crucial during the management of AK, as delayed diagnosis often results in poor clinical outcomes. Currently, AK diagnosis is primarily achieved through a combination of clinical suspicion, microbiological investigations and corneal imaging. Historically, corneal scraping for microbiological culture has been considered to be the gold standard. Despite its technical ease, accessibility and cost-effectiveness, the long diagnostic turnaround time and variably low sensitivity of microbiological culture limit its use as a sole diagnostic test for AK in clinical practice. In this review, we aim to provide a comprehensive overview of the diagnostic modalities that are currently used to diagnose AK, including microscopy with staining, culture, corneal biopsy, in vivo confocal microscopy, polymerase chain reaction and anterior segment optical coherence tomography. We also highlight emerging techniques, such as next-generation sequencing and artificial intelligence-assisted models, which have the potential to transform the diagnostic landscape of AK.

Funder

Medical Research Council/Fight for Sight Clinical Research Fellowship

Fight for Sight/John Lee, Royal College of Ophthalmologists Primer Fellowship

National Institute for Health and Care Research

Publisher

MDPI AG

Subject

Clinical Biochemistry

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