5. Conclusion
Acanthamoeba keratitis is a potentially devastating disease that, although rare, constantly presents difficulties in diagnosis and treatment. Since the first cases in 1973, we have expanded our knowledge of the clinical manifestations of the disease and have come to recognise them. Recent advances of PCR and confocal microscopy have started to improve our diagnostic ability greatly, and as they become more recognised and available, it is hoped that they will serve us more in clinical practice. Treatment still relies on topical biguanides and diamidines as the mainstay of treatment for straightforward cases, but we have also learnt that steroids may be used safely in cases with a significant inflammation. Surgery has been necessary for resistant disease, and we have seen that DLK may provide good outcomes whilst maintaining the host endothelium. Laser photokeratectomy may become more important as we continue to explore its indications. Cross-linking needs further study, as initial case reports show promise, as a useful adjunct to surgery, or possibly even a treatment modality in its own right.