2008 OMIG, Abstract 16

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Clinical Experience with Acanthamoeba Keratitis at the Cole Eye Institute, 1999-2008  
Qian Y, Meisler DM, Langston RHS, Jeng BH.
Cole Eye Institute, Cleveland Clinic, Cleveland, OH

Purpose: To review the clinical presentations, risk factors, medical and surgical management, and outcomes of patients with acanthamoeba keratitis (AK).
Methods: Retrospective review of medical records of all patients suspected for having AK from January 1999 through May 2008 at Cole Eye Institute.
Results: Thirty-one eyes of 28 patients were identified as having either culture or tissue proven AK or presumed AK based on clinical exam and response to treatment.  The mean age was 35.5 years (range 13-61).  Mean follow-up was 22.1 months (range 0-72).  Risk factors identified for AK were exposure to contaminated water, poor CL hygiene, overnight wear of CL, and history of trauma.  Twenty-three of 31 (74.2%) eyes presented with pain.  The average duration of symptoms prior to diagnosis was 6.7 weeks (range 0-36).  Clinical presentations included early AK: epithelial disease only in 9 of 31 (29%) eyes or perineuritis in 6 of 31 (19.4%) eyes, or late AK: stromal disease with or without epithelial disease in 22 of 31 (71%) eyes or ring infiltrate in 10 of 31 (32.3%) eyes.  Most eyes were treated with combination topical polyhexamethylene biguanide, propamidine, neomycin, or chlorhexidine eyedrops.  Oral itraconazole was given in 19 of 29 (65.5%) cases.  Mean duration of topical treatment was 7.5 months (range 0.3-22).  All 7 early AK cases had best corrected visual acuity of 20/30 or better at last followup.  Seven of 11 (63.6%) late AK cases achieved 20/30 or better. Complications from AK (cataract, glaucoma) were observed in 6 of 29 (20.7%) patients.  Eight of 29 eyes underwent surgical intervention.  Five patients had recurrences of AK.  One patient demonstrated cysts in the corneal button, despite 15 months of maximum medical treatment and 5 months off all medical treatment.
Conclusions: The most common risk factor for AK continues to be CL wear.  AK requires prolonged and intense treatment, although good final visual acuity can be achieved.  Acanthamoeba cysts can still persist in a non-inflamed cornea after extensive medical therapy.

Supported in part by a Research to Prevent Blindness Challenge Grant and NIH 1KL2 RR24990 Multidisciplinary Clinical Research Training Grant (BHJ).

Disclosure Code: N