Acanthamoeba keratitis (AK) is a severe cause of infectious keratitis and represents a significant clinical challenge. Recent literature regarding AK epidemiology, diagnosis, treatment modalities, and prognosis is reviewed and synthesized to propose an algorithmic protocol for AK management. Globally, AK outbreaks in developed countries are ongoing, and AK rates have increased. Moreover, current outbreaks may carry a worse prognosis than prior outbreaks. Despite identification of contact lens solutions implicated in AK outbreaks and the consequent market recall of these products, outbreaks persist. Acanthamoeba keratitis afflicts not only refractive soft contact lens users but also cosmetic contact lens users and gas permeable (especially orthokeratology) lens users. Innovations in in vivo confocal microscopy and PCR assays have increased the role for these adjuvant tests alongside corneal smear and culture in a multimodal diagnostic approach to suspected AK. Biguanides (such as chlorhexidine and polyhexamethylene biguanide) and diamidines (propamidine isethionate and hexamidine) remain cornerstones of AK management, and evidence for other treatment modalities continues to evolve. Voriconazole in topical and systemic forms may be useful as adjuvant therapy. The anti-leishmaniasis drug miltefosine, recently given orphan drug status by the United States Food and Drug Administration, has increasing evidence supporting a role in patients with severe/refractory disease. Prior topical corticosteroids have been consistently shown to be associated with worse outcomes in AK. Although not historically thought of as a treatment modality, benzalkonium chloride preservative may be leveraged for its anti-Acanthamoebal properties. The role of Rose-Bengal photodynamic antimicrobial therapy is evolving in selected cases of AK.

棘阿米巴角膜炎 (AK) 是感染性角膜炎的严重原因，是一项重大的临床挑战。回顾和综合了有关 AK 流行病学、诊断、治疗方式和预后的最新文献，提出了 AK 管理的算法方案。在全球范围内，发达国家的 AK 疫情仍在持续，AK 发病率有所上升。此外，目前的暴发可能比以前的暴发预后更差。尽管发现了与 AK 暴发有关的隐形眼镜解决方案，并因此对这些产品进行了市场召回，但暴发仍然存在。棘阿米巴角膜炎不仅困扰着屈光性软性隐形眼镜使用者，还困扰着美容隐形眼镜使用者和透气性（尤其是角膜塑形术）镜片使用者。创新体内共聚焦显微镜和 PCR 检测增加了这些辅助检测以及角膜涂片和培养在疑似 AK 的多模式诊断方法中的作用。双胍类药物（如洗必泰和聚六亚甲基双胍）和二脒类药物（丙脒羟乙基磺酸盐和己脒）仍然是 AK 治疗的基石，其他治疗方式的证据也在不断发展。局部和全身形式的伏立康唑可用作辅助治疗。抗利什曼病药物米替福新最近被美国食品和药物管理局授予孤儿药地位，越来越多的证据支持在严重/难治性疾病患者中的作用。先前的局部皮质类固醇一直被证明与 AK 的较差结果有关。虽然历史上不被认为是一种治疗方式，棘阿米巴属性。Rose-Bengal 光动力抗菌治疗在选定的 AK 病例中的作用正在发展。