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Crosslinking and corneal cryotherapy in acanthamoeba keratitis — a histological study

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Abstract

Purpose

Acanthamoeba keratitis is rare, but difficult to treat. Penetrating keratoplasty is performed in therapy-resistant cases. Nevertheless, subsequent recurrences occur in 40 % of the cases. In addition to triple-topical therapy (polyhexamid, propamidinisoethionat, neomycin), treatment alternatives are corneal cryotherapy and/or crosslinking (CXL). The aim of our present histological study was to analyze the persistence of acanthamoebatrophozoites and cysts, the persistence of bacteria, and activation of keratocytes in corneas of acanthamoeba keratitis patients following corneal cryotherapy and/or CXL.

Patients and methods

We analyzed histologically corneal buttons (from penetrating keratoplasties) of nine patients with acanthamoeba keratitis, following corneal cryotherapy (two patients) or a combination of crosslinking and corneal cryotherapy (seven patients), using haematoxilin–eosin, periodic acid Schiff (PAS), Gram and alpha-smooth muscle actin (alpha-SMA) stainings.

Results

Acanthamoeba trophozoites persisted in three corneas after cryotherapy and CXL. Cysts persisted in one of two corneas following corneal cryotherapy and in six of seven corneas after a combination of CXL and cryotherapy. One cornea showed positive Gram staining, but there were no alpha-SMA positive keratocytes in any of the corneas.

Conclusions

Crosslinking and corneal cryotherapy have only limited impact on killing of acanthamoeba trophozoites, cysts, or bacteria. Corneal cryotherapy and CXL did not stimulate myofibroblastic transformation of keratocytes.

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Authors and Affiliations

  1. Department of Ophthalmology, Saarland University Medical Center, Kirrberger Str. 1, Homburg, Saar , D-66424, Germany

    Tobias Hager, T. Stachon, B. Seitz & N. Szentmáry

  2. Department of Pathology, Saarland University, Homburg, Saar, Germany

    A. Hasenfus

Authors
  1. Tobias Hager
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  2. A. Hasenfus
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  3. T. Stachon
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  4. B. Seitz
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  5. N. Szentmáry
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Correspondence to Tobias Hager.

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No funding was received for this research.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Hager, T., Hasenfus, A., Stachon, T. et al. Crosslinking and corneal cryotherapy in acanthamoeba keratitis — a histological study. Graefes Arch Clin Exp Ophthalmol 254, 149–153 (2016). https://doi.org/10.1007/s00417-015-3189-6

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  • DOI: https://doi.org/10.1007/s00417-015-3189-6

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