{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:42:28Z","timestamp":1760035348291,"version":"build-2065373602"},"reference-count":65,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2025,7,5]],"date-time":"2025-07-05T00:00:00Z","timestamp":1751673600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100010621","name":"Medical University of Lublin","doi-asserted-by":"publisher","award":["DS43","DS179"],"award-info":[{"award-number":["DS43","DS179"]}],"id":[{"id":"10.13039\/501100010621","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Department of Biology and Medical Parasitology, Pozna\u0144 University of Medical Sciences","award":["DS43","DS179"],"award-info":[{"award-number":["DS43","DS179"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objectives: The aim was to present the complicated diagnostic and therapeutic process of atypical, painless keratitis caused by a cosmopolitan protozoan of the genus Acanthamoeba. Methods: This Case Report describes a medical case involving a 48-year-old woman who occasionally wears soft contact lenses and was referred to our hospital for treatment due to deteriorating visual acuity in her left eye. The diagnostic process included the isolation of amoebae from corneal scrapings and the morphological and molecular identification of the etiological agent of the infection. Results: After examination, painless atypical keratitis was diagnosed, initially considered recurrent herpetic keratitis. However, antiviral treatment did not bring about any improvement. Further observation revealed a dense, central, annular infiltrate on the periphery of the cornea. Despite treatment, the corneal infiltrate did not improve and the patient required therapeutic penetrating keratoplasty. Ultimately, the patient underwent combined surgery: corneal transplantation with cataract phacoemulsification and intraocular lens implantation. The postoperative course was uneventful. Conclusions: Acanthamoeba keratitis should be included in the differential diagnosis of keratitis, even in the absence of its characteristic feature of severe ocular pain, especially in contact lens wearers and patients who have had herpetic keratitis. Infection of the cornea with the Herpes simplex type 1 virus causes nerve degeneration, which probably translates into a painless course of Acanthamoeba castellanii infection.<\/jats:p>","DOI":"10.3390\/jcm14134763","type":"journal-article","created":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T06:03:13Z","timestamp":1751868193000},"page":"4763","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Complicated Diagnosis and Treatment of Rare Painless Acanthamoeba Keratitis"],"prefix":"10.3390","volume":"14","author":[{"given":"Dominika","family":"Wr\u00f3bel-Dudzi\u0144ska","sequence":"first","affiliation":[{"name":"Department of Diagnostic and Microsurgery of Glaucoma, Medical University of Lublin, Chmielna 1 Street, 20-079 Lublin, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4039-9522","authenticated-orcid":false,"given":"Marta","family":"Ziaja-So\u0142tys","sequence":"additional","affiliation":[{"name":"Department of Biology with Genetics, Medical University of Lublin, Witolda Chod\u017aki 4A Street, 20-093 Lublin, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Beata","family":"Rymgay\u0142\u0142o-Jankowska","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Microsurgery of Glaucoma, Medical University of Lublin, Chmielna 1 Street, 20-079 Lublin, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monika","family":"Derda","sequence":"additional","affiliation":[{"name":"Department of Biology and Medical Parasitology, Poznan University of Medical Sciences, H. Swiecicki Street 4, 60-781 Poznan, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Klepacz","sequence":"additional","affiliation":[{"name":"Department of Clinical Pathology, Medical University of Lublin, Jaczewskiego 8B Street, 20-090 Lublin, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2254-2009","authenticated-orcid":false,"given":"Daniel","family":"Zalewski","sequence":"additional","affiliation":[{"name":"Department of Biology with Genetics, Medical University of Lublin, Witolda Chod\u017aki 4A Street, 20-093 Lublin, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomasz","family":"\u017barnowski","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Microsurgery of Glaucoma, Medical University of Lublin, Chmielna 1 Street, 20-079 Lublin, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8473-7429","authenticated-orcid":false,"given":"Anna","family":"Bogucka-Kocka","sequence":"additional","affiliation":[{"name":"Department of Biology with Genetics, Medical University of Lublin, Witolda Chod\u017aki 4A Street, 20-093 Lublin, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Peguda, H.K., Lakshminarayanan, R., Carnt, N.A., Gu, Z., and Willcox, M.D.P. (2022). The Activity of Polyhomoarginine against Acanthamoeba Castellanii. Biology, 11.","DOI":"10.3390\/biology11121726"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Chomicz, L., Szaflik, J.P., Szostakowska, B., Izdebska, J., Baltaza, W., \u0141azicka-Ga\u0142ecka, M., Kuligowska, A., Machali\u0144ska, A., Zawadzki, P.J., and Szaflik, J. (2023). Successive Acanthamoeba Corneal Isolates Identified in Poland Monitored in Terms of In Vitro Dynamics. Microorganisms, 11.","DOI":"10.3390\/microorganisms11051174"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Randag, A.C., van Rooij, J., van Goor, A.T., Verkerk, S., Wisse, R.P.L., Saelens, I.E.Y., Stoutenbeek, R., van Dooren, B.T.H., Cheng, Y.Y.Y., and Eggink, C.A. (2019). The Rising Incidence of Acanthamoeba Keratitis: A 7-Year Nationwide Survey and Clinical Assessment of Risk Factors and Functional Outcomes. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0222092"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1621","DOI":"10.1136\/bjophthalmol-2018-312544","article-title":"Acanthamoeba Keratitis: Confirmation of the UK Outbreak and a Prospective Case-Control Study Identifying Contributing Risk Factors","volume":"102","author":"Carnt","year":"2018","journal-title":"Br. J. Ophthalmol."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Gon\u00e7alves, D.d.S., Ferreira, M.d.S., and Guimar\u00e3es, A.J. (2019). Extracellular Vesicles from the Protozoa Acanthamoeba Castellanii: Their Role in Pathogenesis, Environmental Adaptation and Potential Applications. Bioengineering, 6.","DOI":"10.3390\/bioengineering6010013"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/1756-3305-5-6","article-title":"Biology and Pathogenesis of Acanthamoeba","volume":"5","author":"Siddiqui","year":"2012","journal-title":"Parasit. Vectors"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1111\/j.1574-6976.2006.00023.x","article-title":"Acanthamoeba: Biology and Increasing Importance in Human Health","volume":"30","author":"Khan","year":"2006","journal-title":"FEMS Microbiol. Rev."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Hassan, F.A.M., Tolba, M.E.M., Abed, G.H., Omar, H.M., and Abdel-Hakeem, S.S. (2021). Contact Lenses Contamination by Acanthamoeba spp. in Upper Egypt. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0259847"},{"key":"ref_9","first-page":"CD010792","article-title":"Medical Interventions for Acanthamoeba Keratitis","volume":"2015","author":"Alkharashi","year":"2015","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.joco.2018.09.008","article-title":"Acanthamoeba Keratitis\u2014Clinical Signs, Differential Diagnosis and Treatment","volume":"31","author":"Daas","year":"2019","journal-title":"J. Curr. Ophthalmol."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Sifaoui, I., Capote Yanes, E., Reyes-Batlle, M., Rodr\u00edguez-Exp\u00f3sito, R.L., Pi\u00f1ero, J.E., and Lorenzo-Morales, J. (2020). Combined Amoebicidal Effect of Atorvastatin and Commercial Eye Drops against Acanthamoeba Castellanii Neff: In Vitro Assay Based on Mixture Design. Pathogens, 9.","DOI":"10.3390\/pathogens9030219"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1007\/s00436-012-2849-2","article-title":"Molecular Characterization of Acanthamoeba Isolated in Water Treatment Plants and Comparison with Clinical Isolates","volume":"111","author":"Magnet","year":"2012","journal-title":"Parasitol. Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.micres.2016.08.001","article-title":"Acanthamoeba spp. as a Universal Host for Pathogenic Microorganisms: One Bridge from Environment to Host Virulence","volume":"193","author":"Guimaraes","year":"2016","journal-title":"Microbiol. Res."},{"key":"ref_14","unstructured":"Somani, S.N., Ronquillo, Y., and Moshirfar, M. (2025). Acanthamoeba Keratitis. StatPearls, StatPearls Publishing."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1016\/j.jiph.2023.03.020","article-title":"The Global Epidemiology and Clinical Diagnosis of Acanthamoeba Keratitis","volume":"16","author":"Zhang","year":"2023","journal-title":"J. Infect. Public Health"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Azzopardi, M., Chong, Y.J., Ng, B., Recchioni, A., Logeswaran, A., and Ting, D.S.J. (2023). Diagnosis of Acanthamoeba Keratitis: Past, Present and Future. Diagnostics, 13.","DOI":"10.3390\/diagnostics13162655"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.clae.2014.11.146","article-title":"Acanthamoeba Keratitis: 10-Year Study at a Tertiary Eye Care Center in Hong Kong","volume":"38","author":"Chin","year":"2015","journal-title":"Cont. Lens Anterior Eye"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1051\/parasite\/2015010","article-title":"An Update on Acanthamoeba Keratitis: Diagnosis, Pathogenesis and Treatment","volume":"22","author":"Khan","year":"2015","journal-title":"Parasite"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1016\/S0039-6257(98)00004-6","article-title":"Acanthamoeba Keratitis","volume":"42","author":"Illingworth","year":"1998","journal-title":"Surv. Ophthalmol."},{"key":"ref_20","first-page":"170","article-title":"Peripheral nervous system involvement in the course of herpes virus infections","volume":"47","author":"Kozubski","year":"2013","journal-title":"Neurol. Neurochir. Pol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Amponin, D.E., Przybek-Skrzypecka, J., Zyablitskaya, M., Takaoka, A., Suh, L.H., Nagasaki, T., Trokel, S.L., and Paik, D.C. (2020). Ex Vivo Anti-Microbial Efficacy of Various Formaldehyde Releasers against Antibiotic Resistant and Antibiotic Sensitive Microorganisms Involved in Infectious Keratitis. BMC Ophthalmol., 20.","DOI":"10.1186\/s12886-020-1306-8"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1128\/CMR.16.2.273-307.2003","article-title":"Acanthamoeba spp. as Agents of Disease in Humans","volume":"16","author":"Cabral","year":"2003","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1002\/jcp.25623","article-title":"Understanding the Pathogenesis of Neurotrophic Keratitis: The Role of Corneal Nerves","volume":"232","author":"Mastropasqua","year":"2017","journal-title":"J. Cell Physiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1016\/S0014-4835(03)00050-2","article-title":"Corneal Nerves: Structure, Contents and Function","volume":"76","author":"Marfurt","year":"2003","journal-title":"Exp. Eye Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.exer.2013.08.011","article-title":"The Role of Corneal Afferent Neurons in Regulating Tears under Normal and Dry Eye Conditions","volume":"117","author":"Meng","year":"2013","journal-title":"Exp. Eye Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"67","DOI":"10.17925\/USOR.2022.16.2.67","article-title":"Neurotrophic Keratitis: A Review","volume":"16","author":"Duncan","year":"2022","journal-title":"Touchreviews Ophthalmol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1038\/eye.2011.270","article-title":"Corneal Nerve Alterations in Acute Acanthamoeba and Fungal Keratitis: An in Vivo Confocal Microscopy Study","volume":"26","author":"Kurbanyan","year":"2012","journal-title":"Eye"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1016\/j.ajo.2009.06.009","article-title":"Acanthamoeba Keratitis: Diagnosis and Treatment Update 2009","volume":"148","author":"Dart","year":"2009","journal-title":"Am. J. Ophthalmol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1097\/00003226-200110000-00017","article-title":"Atypical Presentation of Acanthamoeba Keratitis","volume":"20","author":"Tabin","year":"2001","journal-title":"Cornea"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1016\/j.jcjo.2012.04.015","article-title":"Painless Acanthamoeba Keratitis","volume":"47","author":"Robert","year":"2012","journal-title":"Can. J. Ophthalmol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"989","DOI":"10.1038\/sj.eye.6700616","article-title":"Neurotrophic Keratitis","volume":"17","author":"Bonini","year":"2003","journal-title":"Eye"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1126\/science.163.3867.576.a","article-title":"Amoebic Meningoencephalitis: Axenic Culture of Naegleria","volume":"163","author":"Cerva","year":"1969","journal-title":"Science"},{"key":"ref_33","unstructured":"Page, F. (1967). An Illustrated Key to Freshwater and Soil Amoebae, Freshwater Biological Association."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1903","DOI":"10.1128\/JCM.39.5.1903-1911.2001","article-title":"Use of Subgenic 18S Ribosomal DNA PCR and Sequencing for Genus and Genotype Identification of Acanthamoebae from Humans with Keratitis and from Sewage Sludge","volume":"39","author":"Schroeder","year":"2001","journal-title":"J. Clin. Microbiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1233","DOI":"10.1007\/s00436-015-4319-0","article-title":"Genotypic Characterization of Amoeba Isolated from Acanthamoeba Keratitis in Poland","volume":"114","author":"Derda","year":"2015","journal-title":"Parasitol. Res."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/j.vetpar.2010.02.028","article-title":"Isolation, Morphologic, Serologic and Molecular Identification of Acanthamoeba T4 Genotype from the Liver of a Temminck\u2019s Tragopan (Tragopan Temminckii)","volume":"170","author":"Visvesvara","year":"2010","journal-title":"Vet. Parasitol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"6363","DOI":"10.1167\/iovs.13-11990","article-title":"Antimicrobial Action of Biguanides on the Viability of Acanthamoeba Cysts and Assessment of Cell Toxicity","volume":"54","author":"Mafra","year":"2013","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1111\/j.1462-2920.2008.01752.x","article-title":"Novel Chlamydiales Strains Isolated from a Water Treatment Plant","volume":"11","author":"Corsaro","year":"2009","journal-title":"Environ. Microbiol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.1136\/bjo.2007.132266","article-title":"The Genotypic Characterisation of Acanthamoeba Isolates from Human Ocular Samples","volume":"92","author":"Yera","year":"2008","journal-title":"Br. J. Ophthalmol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1007\/s10096-007-0268-6","article-title":"Comparison of PCR, Microscopic Examination and Culture for the Early Diagnosis and Characterization of Acanthamoeba Isolates from Ocular Infections","volume":"26","author":"Yera","year":"2007","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"752","DOI":"10.1007\/s00347-014-3225-7","article-title":"The German Acanthamoeba keratitis register: Initial results of a multicenter study","volume":"112","author":"Daas","year":"2015","journal-title":"Ophthalmologe"},{"key":"ref_42","first-page":"521","article-title":"Acanthamoeba keratitis--a rare and often late diagnosed disease","volume":"229","author":"Goebels","year":"2012","journal-title":"Klin. Monbl Augenheilkd."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.ajo.2019.01.024","article-title":"The Acanthamoeba-Fungal Keratitis Study","volume":"201","author":"Raghavan","year":"2019","journal-title":"Am. J. Ophthalmol."},{"key":"ref_44","unstructured":"Osato, M., and Wilhalmus, K. (1994). Infectious Keratitis. Cornea, Little, Brown."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1038\/eye.1993.168","article-title":"A Review of 72 Consecutive Cases of Acanthamoeba Keratitis, 1984\u20131992","volume":"7","author":"Bacon","year":"1993","journal-title":"Eye"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1097\/OPX.0000000000001023","article-title":"Painless Acanthamoeba Keratitis with Normal Vision","volume":"94","author":"Kwok","year":"2017","journal-title":"Optom. Vis. Sci."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"207","DOI":"10.3109\/02713688709020092","article-title":"Herpes Simplex Masquerade Syndrome: Acanthamoeba Keratitis","volume":"6","author":"Johns","year":"1987","journal-title":"Curr. Eye Res."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1097\/ICO.0000000000000804","article-title":"Update on Acanthamoeba Keratitis: Diagnosis, Treatment, and Outcomes","volume":"35","author":"Maycock","year":"2016","journal-title":"Cornea"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"769","DOI":"10.2307\/3283890","article-title":"In Vitro Destruction of Nerve Cell Cultures by Acanthamoeba spp.: A Transmission and Scanning Electron Microscopy Study","volume":"82","author":"Pettit","year":"1996","journal-title":"J. Parasitol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1016\/j.jcjo.2012.03.040","article-title":"Prognostic Factors in Acanthamoeba Keratitis","volume":"47","author":"Kaiserman","year":"2012","journal-title":"Can. J. Ophthalmol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1565","DOI":"10.1016\/S0161-6420(95)30830-5","article-title":"Decreased Corneal Sensation as an Initial Feature of Acanthamoeba Keratitis","volume":"102","author":"Perry","year":"1995","journal-title":"Ophthalmology"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.1136\/bjo.84.10.1103","article-title":"Patient Characteristics, Diagnosis, and Treatment of Non-Contact Lens Related Acanthamoeba Keratitis","volume":"84","author":"Sharma","year":"2000","journal-title":"Br. J. Ophthalmol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1055\/s-2001-17140","article-title":"Painless acanthamoeba keratitis","volume":"218","author":"Roters","year":"2001","journal-title":"Klin. Monbl Augenheilkd."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1097\/01.icl.0000189042.91077.a0","article-title":"Unusual Case of Acanthamoeba Keratitis in a Contact Lens Wearer","volume":"32","author":"Georgakopoulos","year":"2006","journal-title":"Eye Contact Lens"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1007\/s00347-006-1462-0","article-title":"Painless acanthamoeba keratitis","volume":"104","author":"Stemberger","year":"2007","journal-title":"Ophthalmologe"},{"key":"ref_56","first-page":"951","article-title":"Painless Acanthamoeba Keratitis in a Soft Contact Lens Wearer\u2014Case Report","volume":"33","author":"Elabjer","year":"2009","journal-title":"Coll. Antropol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"300060519895671","DOI":"10.1177\/0300060519895671","article-title":"Clinical Diagnosis and Treatment of Rare Painless Keratitis Caused by Three Pathogens: Clinical Practice and Experiential Discussion","volume":"48","author":"Sun","year":"2020","journal-title":"J. Int. Med. Res."},{"key":"ref_58","first-page":"e48129","article-title":"Different Outcomes of Acanthamoeba Keratitis: A Case Series","volume":"15","author":"Lin","year":"2023","journal-title":"Cureus"},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"List, W., Glatz, W., Riedl, R., Mossboeck, G., Steinwender, G., and Wedrich, A. (2021). Evaluation of Acanthamoeba Keratitis Cases in a Tertiary Medical Care Centre over 21 Years. Sci. Rep., 11.","DOI":"10.1038\/s41598-020-80222-3"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1016\/j.ajo.2007.08.040","article-title":"Comparison of Polyhexamethylene Biguanide and Chlorhexidine as Monotherapy Agents in the Treatment of Acanthamoeba Keratitis","volume":"145","author":"Lim","year":"2008","journal-title":"Am. J. Ophthalmol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1016\/S0002-9394(14)74320-X","article-title":"Medical and Surgical Treatment of Acanthamoeba Keratitis","volume":"103","author":"Cohen","year":"1987","journal-title":"Am. J. Ophthalmol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1097\/ICO.0b013e31826429bd","article-title":"Prognostic Factors Associated with the Need for Surgical Treatments in Acanthamoeba Keratitis","volume":"32","author":"Bouheraoua","year":"2013","journal-title":"Cornea"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.ophtha.2014.07.052","article-title":"Therapeutic and Optical Keratoplasty in the Management of Acanthamoeba Keratitis: Risk Factors, Outcomes, and Summary of the Literature","volume":"122","author":"Robaei","year":"2015","journal-title":"Ophthalmology"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"2889","DOI":"10.1007\/s10792-019-01137-1","article-title":"Therapeutic Penetrating Keratoplasty for Acanthamoeba Keratitis: A Review of Cases, Complications and Predictive Factors","volume":"39","author":"Roozbahani","year":"2019","journal-title":"Int. Ophthalmol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"648","DOI":"10.1007\/s00417-003-0805-7","article-title":"Delay in Diagnosis and Outcome of Acanthamoeba Keratitis","volume":"242","author":"Claerhout","year":"2004","journal-title":"Graefes Arch. Clin. Exp. Ophthalmol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/13\/4763\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:05:04Z","timestamp":1760033104000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/13\/4763"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,5]]},"references-count":65,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["jcm14134763"],"URL":"https:\/\/doi.org\/10.3390\/jcm14134763","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2025,7,5]]}}}