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2007 OMIG, Abstract 19

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Risk Factors and Means of Detection of Acanthamoeba Keratitis at the New York Eye and Ear Infirmary 2005-2007:
Lior Haim, Boris Ovodenko, Mahendra Shah, David Ritterband, John Seedor.  Departments of Ophthalmology and Laboratory Medicine, The New York Eye and Ear Infirmary, New York, NY and New York Medical College, Valhalla, NY

Purpose:To determine the risk factors and optimal detection methods for Acanthamoeba keratitis at the New York Eye and Ear Infirmary 2005-2007.
Methods:The medical records of 21 cases of Acanthamoeba keratitis from Jamuary 2005- August 2007 were collected.  The records were reviewed and the following information was tabulated: patient demographics, medical history, risk factors for Acanthamoeba keratitis (including contact lens usage, cleansing solution used, overnight usage, method of cleansing, trauma, etc.), mode of detection, culture media employed, and clinical outcomes.
Results:Of the 21 cases, 19 presented after 2005, 17 were in contact lens users, 3 were related to trauma, and 1 was related to possible contaminated water exposure without contact lens usage.  Of the 2 cases presenting prior to December 2005 one was in a contact lens user and one was in a trauma patient. Both were diagnosed by pathology sections of the cornea.   10/19 cases had positive corneal cultures and 9/19 had visible cysts by confocal microscopy.  Six cases were diagnosed with acanthamoeba keratitis by slit exam, history and response to anti-amoebic therapy alone. All 10 cases with positive cultures were detected after December 2006, after switching media from a non-nutrient agar with an Enterobacter cloacae overlay instead of E. coli. Of the 17 contact lens users 7/17 (41%) were using AMO Complete® cleansing solution, 5/17 (29%) were using Bausch & Lomb Moisture Loc® solution, and 1/17 were using both solutions.  Risk factors included overnight contact lens usage (4/17), exposure to contaminated water (5/17), extended usage (>12 hours per day) (4/17), and infrequently replenishing solution in between contact lens usage (2/17).
Conclusions:Our Acanthamoeba outbreak began in October of 2006 nearly 12-18 months after those reported in Philadelphia and Chicago. Corneal culture and confocal microscopy seem to be very effective modes of detection. Switching to an Enterobacter cloacae overlay instead of E. coli dramatically improved our culture yield. There was an association between the type of contact lens solution a patient used and the acquisition of acanthamoeba keratitis.


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