Clinical Outcomes and Prognostic Factors Associated With Acanthamoeba Keratitis

Cornea Service, Wills Eye Institute, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
Cornea (Impact Factor: 2.04). 10/2010; 30(4):435-41. DOI: 10.1097/ICO.0b013e3181ec905f
Source: PubMed


To describe the clinical characteristics, time of presentation, risk factors, treatment, outcomes, and prognostic factors on a recent series of Acanthamoeba keratitis (AK) treated at our institution.
Retrospective case series of 59 patients diagnosed with AK from January 1, 2004 to December 31, 2008. Of these 59 patients, 51 had complete follow-up data and were analyzed using univariate and multivariate logistic regression analyses performed with "failure" defined as requiring a penetrating keratoplasty (PKP) and/or having (1) best-corrected visual acuity (BCVA) < 20/100 or (2) BCVA < 20/25 at the last follow-up. A single multivariate model incorporating age, sex, steroid use before diagnosis, time to diagnosis, initial visual acuity (VA), stromal involvement, and diagnostic method was performed.
Symptom onset was greatest in the summer and lowest in the winter. With failure defined as requiring PKP and/or final BCVA < 20/100, univariate analysis suggests that age > 50 years, female sex, initial VA < 20/50, stromal involvement, and patients with a confirmed tissue diagnosis had a significant risk for failure; however, none of these variables were significant using multivariate analysis. Univariate analysis, with failure defined as requiring PKP and/or final BCVA < 20/25, showed stromal involvement and initial VA < 20/50 were significant for failure-only initial VA < 20/50 was significant using multivariate analysis.
Symptom onset for AK is greatest in the summer. Patients with confirmed tissue diagnosis and female patients may have a higher risk for failure, but a larger prospective population-based study is required to confirm this. Failure is likely associated with patients who present with stromal involvement and patients presenting with an initial BCVA worse than 20/50.

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    • "For example, Ehlers and Hjortdal [3] reported 2 cases with a white cataract, secondary glaucoma, and iris atrophy after prolonged treatment with 0.02% chlorhexidine and 0.1% propamidine isethionate. Cataract, iris atrophy, and ischemic ocular inflammation are associated with chlorhexidine use [3, 4] or topical polyhexamethylene biguanide 0.02% [2] in patients with AK. Cationic compounds such as chlorhexidine can disrupt the lens surface, provoke lenticular oxidative or osmotic stress, and contribute to cataract formation by altering lipid membranes, damaging lens fibers, and inducing electrolyte imbalances [5]. "
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    ABSTRACT: To show the evolution of anterior chamber structures 6 years after cataract surgery in a case with Acanthamoeba keratitis (AK). A 37-year-old woman with AK receiving long-term treatment with chlorhexidine, propamidine isethionate and steroids developed a white cataract and iris atrophy. Penetrating keratoplasty and cataract surgery were performed with subsequent intraocular pressure elevation requiring Molteno shunt implantation. Two years after the last surgery, endothelial decompensation developed and another penetrating keratoplasty was performed. Intraoperatively, the anterior and posterior capsules were completely transparent. Six years after cataract surgery, the intraocular lens was centered with clear anterior and posterior capsules without lens epithelial cells proliferation. No Soemmering's ring formation or posterior capsule opacification was found. Also, no zonular damage or pseudophacodonesis was observed. This case suggests that AK infection and AK treatment not only cause white progressive cataract but also lens epithelial cell death. The capsules may be completely clear 6 years after cataract surgery, with a good quality of vision regardless of intraocular lens material or design.
    Full-text · Article · Sep 2011 · Case Reports in Ophthalmology
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    ABSTRACT: Ein 35-jähriger Patient stellte sich mit einem seit Monaten extern behandelten Hornhautulkus links vor. Bei Erstuntersuchung bei uns zeigten sich eine elliptisch konfigurierte, ulzerierend nekrotisierende, stromale Keratitis, zirkuläre oberflächliche und tiefe korneale Neovaskularisationen und ein organisiertes Hypopyon mit Hyphaema (Visus: Lichtschein-intakte Projektion). Der Patient gab an, Kontaktlinsenträger zu sein. Bei anfänglicher „Dendritica-Figur“ der Hornhaut war er extern 6 Monate lang (4 davon stationär) mit dem Verdacht auf Herpes-simplex-Keratitis behandelt worden. Unsere Diagnose lautete Akanthamöbenkeratitis. Es erfolgte eine elliptisch perforierende Keratoplastik-à-chaud mit dem Excimerlaser (8,0 × 7,0 mm/8,1 × 7,1 mm) mit simultaner Kryotherapie der mittelperipheren Hornhaut (postoperativer Visus 0,1). Die Lokaltherapie bestand aus Polyhexamethylenbiguanid, Propamidinisoethionat, Neomycin und Steroiden im Intervall. Bei Transplantateinschmelzung und aufgehobener Vorderkammer erfolgten 2 Monate später eine erneute elliptisch perforierende Excimerlaser-Keratoplastik (8,5 × 7,5 mm/8,6 × 7,6 mm) sowie eine simultane Amnionmembrantransplantation als Patch und eine laterale Tarsorrhaphie. Nach Operation einer maturen Katarakt betrug der Visus links 0,8. Die Akanthamöbenkeratitis sollte bei Patienten mit positiver Kontaktlinsenanamnese immer frühzeitig in Betracht gezogen werden.
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