The Charles T. Campbell Eye Microbiology Lab
UPMCUniversity of Pittsburgh Schools of the Health Sciences
HomeContact InformationLab Diagnostic TestingAntibiotic SusceptibilityAntimicrobial TherapyCurrent ResearchPhotos

Ocular Microbiology and Immunology Group
Back to OMIG Main Page

2011 Abstract List | < Previous | Next >

2011 OMIG Abstract 22

Acanthamoeba sclerokeratitis (ASK) treated with immunosuppressive therapy
A. Iovieno, J.K.G. Dart    
Moorfields Eye Hospital, London, United Kingdom

Purpose: To describe the clinical outcome of Acanthamoeba sclerokeratitis (ASK) treated with immunosuppressive therapy.

Methods: 25 patients (28 eyes) were included in this retrospective case series (14 M, 11 F; mean age: 39.5 ± 15.9, range: 17-78). Initial diagnosis of Acanthamoeba infection was made clinically and/or by confocal microscopy, and laboratory confirmation was obtained by culture or pathology of corneal specimens. ASK was defined as Acanthamoeba keratitis with clinically manifest ipsilateral scleral inflammation. In all patients, topical 0.02-0.06% polyhexamethylbiguanide (PHMB) or 0.02% chlorhexidine were used as monotherapy or in association with 0.1% propamidine isethionate or 0.1% hexamidine. Topical steroids (dexamethasone 0.1% or prednisolone 0.5%) and oral nonsteroidal antinflammatories (NSAIDS), either flurbiprofen or diclofenac, were used as a first line of treatment, with oral prednisolone and/or cyclosporine substituted for the NSAIDS in more severe cases. Oral azathioprine or mycophenolate were added as a third line of treatment, when needed. Patients were followed for an average of 24.4 ± 21.7 months after discontinuation of scleritis treatment.

Results: The average time between initial symptoms and initiation of specific anti-amoebic treatment was 1.96 ± 1.52 months, respectively. 11/28 eyes had scleritis at first presentation to this hospital.  The average time between the initial symptoms of keratitis and initiation of treatment for scleritis was 6.3 ± 5.4 months. Visual acuity at the onset of ASK was counting fingers (CF) or worse in 18/28 eyes, and between 6/60 and 6/18 in 10/28. Acuity improved in 23/28 eyes: 4/28 were CF or worse; 12/28 between 6/60 and 6/18 and 12/28 better than 6/12. Ten eyes had at least one keratoplasty procedure, three of them for corneal perforation. Pain control was achieved in 27/28 eyes, and none of the patients on immunosuppression developed keratitis relapses or systemic side effects. Two eyes were enucleated and the disease resolved in the rest. Seven eyes developed cataracts and five developed persistent epithelial defects, which required surgical treatment.

Conclusions: Immunosuppressive treatment in association with anti-amebic therapy can effectively control the inflammation, reduce complications and aid visual recovery in ASK.

Disclosures: N

2011 Abstract List | < Previous | Next >