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2009 OMIG, Abstract 9

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Resolution of acanthamoeba keratoconjuncitivitis without the use of anti-acanthamoebal therapy.
L.J. Cervantes, C.Y. Shih, D.C. Ritterband, M. Shah, J.A. Seedor, I.J. Udell
North Shore/Long Island Jewish Health System; New York Eye and Ear Infirmary

Purpose: To describe resolution of acanthamoeba keratoconjunctivitis without the use of anti-acanthamoebal therapy.
Design: Retrospective case series.
Methods:  Charts of all patients presenting with acute keratoconjunctivitis who cultured positive for acanthamoeba (ACA) from the North Shore-Long Island Jewish Hospitals and the New York Eye & Ear Infirmary from July 2007 to July 2009 were reviewed.  Factors such as presenting signs and symptoms, use of contact lenses, exposure of eyes to tap water, use of antibiotics and anti-acanthamoebal medications, and time to resolution were recorded.  Time to resolution was defined as equivalent to length of treatment.
Results: Fourteen eyes presenting with acute keratoconjunctivitis and cultures positive for ACA received empiric treatment without anti-acanthamoebal therapy.  This included 8 eyes with positive corneal cultures, 5 eyes with positive contact lens cultures, and 1 eye with both. Of the patients with positive acanthamoeba cultures, 86% had a history of contact lens wear, 42% of those patients slept in their contacts, or over-wore their contact lenses, and 57% had an exposure to tap water. Reported pain was on average 3.2±3.6/10. Average time to report positive acanthamoeba cultures was 7.1±1.9 days. Therapy consisted of fluoroquinolones (71%), fortified vancomycin (57%), and fortified tobramycin (21%). All stopped wearing their contact lenses. One patient did not receive any drop therapy and simply discontinued his contact lens wear.  Presenting signs included subepithelial infiltrates (64%), superficial punctate epitheliopathy (71%), and corneal ulceration (36%). Time to resolution was 18±14 days.
Conclusions: Cases of acanthamoeba keratoconjunctivitis which are caught early can successfully be treated using empiric broad-spectrum antibiotics and discontinuation of contact lens wear.  A high level of suspicion for acanthamoeba should be maintained in contact lens wearers and patients with a history of exposure to tap water who present with corneal infiltrates, precluding the use of topical steroids in such cases.

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