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2018 Agenda and Abstracts | < Previous Next >

2018 OMIG Abstract

Resolution Of Recurrent Acanthamoeba Keratitis With Oral Miltefosine

Nikhil Dewan, Wendy Ming, Sonia Yeung, Alfonso Iovieno
Department of Ophthalmology, University of British Columbia


Purpose: Acanthamoeba keratitis is a rare vision threatening disease that is most commonly seen in contact lens wearers. Commercially available antiamoebics are poorly cysticidal and highly toxic. Therapeutic keratoplasty is often necessary, but postoperative complications and transplant failure are not uncommon. In this case, we aimed to discuss the novel use of oral miltefosine for the treatment of resistant Acanthamoeba keratitis.

Methods: A 44-year old contact lens wearer presented to the cornea service with a two-week history of red painful eye and decreasing vision. After poorly responding to topical corticosteroid upon the presumptive diagnosis of anterior uveitis, she developed radial keratoneuritis. Corneal scraping was found positive for Acanthamoeba. No clinical response to treatment was observed after 3 months of topical chlorhexidine 0.02% with polyhexamethylene biguanide 0.02%, and with one month of oral voriconazole. The patient therefore underwent two therapeutic keratoplasties, with prompt recurrence of the diseases on the keratoplasty graft.

Results: Decision was taken to add on oral miltefosine50 mg three times daily to the current management. After 8 months, the patient underwent a third penetrating keratoplasty. Hystopathology and microbiology on the excised button were negative for Acanthamoeba. She continued miltefosine for three more months before discontinuation, with no recurrence of the disease observed after 30 months of follow-up.

Conclusion: This case shows, for the first-time, resolution of recalcitrant Acanthamoeba keratitis with oral miltefosine in an immunocompetent patient. Further clinical evidence would be needed to possibly incorporate this medication in the anti-amoebic armamentarium.

Disclosure: N (ND/WM/SY); C, L, O, P (AI) However, none relevant to this study.


2018 Agenda and Abstracts | < Previous Next >