Ocular Microbiology and Immunology Group
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2026 OMIG Abstract

Managing the Inflammatory Milieu of Acanthamoeba Keratitis:
A Decade of Evolving Practice Patterns

Helen Song¹, Felipe E. Tribin², Darlene Miller³, Jaime D. Martinez², Eduardo Alfonso²,
and Guillermo Amescua^2,3

¹University of Illinois Chicago, Department of Ophthalmology and Visual Sciences, Chicago, Illinois; ²Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida; ³Ocular Microbiology Laboratory, Bascom Palmer Eye Institute, University of Miami, Miami, Florida

Purpose: To investigate practice patterns in managing the inflammatory sequelae of Acanthamoeba keratitis (AK) in the pre-PUTT (Parasitic Ulcer Treatment Trial) era, including contexts of paradoxical inflammation following miltefosine use.

Methods: A retrospective review was conducted of all patients initially diagnosed with AK at Bascom Palmer Eye Institute (BPEI) from 2015 - 2026. Patients were divided into two groups based on whether their treatment regimen included miltefosine or without. Further subgroups were identified as follows: no corticosteroid use, established corticosteroid use prior to infection, steroids started prior to anti-amoebic therapy, and steroids started after anti-amoebic therapy.

Results: Of 229 patients identified with a diagnosis of AK, 92 were initially diagnosed and fully treated at BPEI. Patients who received corticosteroids after initiation of anti-amoebic therapy achieved a 66.7% medical cure rate, compared to a 57.7% cure rate in those initiated with corticosteroids before anti-amoebic therapy. Completely steroid-naÏve patients achieved an 80% medical cure rate. Regarding miltefosine, treated patients achieved a 44% medical cure rate, whereas those who did not receive miltefosine resulted in a 70.8% cure rate. Paradoxical, (culture-proven) sterile hyper-inflammatory responses were experienced by 37.5% of patients who received miltefosine; however, in the 62.5% of patients that did not, the majority had been pre-treated with some form of prophylactic steroids.

Conclusions: This data shows the lowest medical cure rates occurred when steroids were initiated prior to the anti-amoebic therapy, likely during a period of diagnostic uncertainty. Conversely, highest cure rates were observed in patients who remained steroid-naÏve, suggesting inflammatory suppression may not be required to achieve clinical resolution. Caution should be exercised with miltefosine use due to the significant risk of sterile inflammatory sequelae following drug administration.