Anterior Scleral and Limbal Inflammatory Necrosis After Adjuvant Miltefosine for Recalcitrant Acanthamoeba Keratitis

Presa, Martin de la; Ibach, Mitch; Berdahl, John P.; Holland, Edward J.

doi:10.1097/ico.0000000000002849

Cited by 6 publications

(2 citation statements)

References 11 publications

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“…On the one hand, Vemuganti et al 4 reported parasite-mediated cytolysis and phagocytosis of corneal cells with destructive granulomatous inflammation in cases of worsening AK. On the other hand, de la Presa et al 9 recently reported a case series demonstrating significant scleral inflammation after miltefosine treatment for AK that had previously spared the sclera. Thus, both inflammatory and infectious components may contribute to clinically observed scleritis.…”

Section: Discussionmentioning

confidence: 99%

Successful Medical and Surgical Management of Recalcitrant Acanthamoeba Keratitis, Scleritis, and Culture-Positive Scleral Abscess

Heath

Riaz

Davis

2023

Cornea

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Purpose: The purpose of this study was to describe the management of a case of recurrent scleritis and Acanthamoeba-positive scleral abscess in a patient after the use of miltefosine for recalcitrant Acanthamoeba keratitis. Methods: This is a case study. Results: In this study, we report a case of advanced Acanthamoeba keratitis with resultant corneal perforation with therapeutic keratoplasty and associated scleritis who later developed a scleral abscess after treatment with oral miltefosine. The scleral abscess was positive for Acanthamoeba cysts and trophozoites, and after treatment for an additional several months, the patient had complete resolution of her disease. Conclusions: Acanthamoeba scleritis is a rare complication associated with Acanthamoeba keratitis. It has traditionally been treated as an immune reaction and associated inflammation, especially with the use of miltefosine. Management can require a multitude of different approaches, and in this situation, it has been demonstrated that scleritis can be infectious and that conservative management can be effective.

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Section: Discussionmentioning

confidence: 99%

Successful Medical and Surgical Management of Recalcitrant Acanthamoeba Keratitis, Scleritis, and Culture-Positive Scleral Abscess

Heath

Riaz

Davis

2023

Cornea

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“…The main side effects noted were nausea and vomiting, and elevated liver enzymes [69]. Several clinicians have reported increased corneal inflammation leading to corneal and scleral melts after initiating miltefosine that required topical and/or oral steroids [69][70][71]. In addition, a recent case report described an occurrence of miltefosine-associated keratopathy that likely occurred from extracellular formation of cholesterol crystals [72].…”

Section: Therapy For Acanthamoeba Keratitismentioning

confidence: 99%

Therapy for contact lens-related ulcers

Jeang

Tuli

2022

Current Opinion in Ophthalmology

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Purpose of reviewThe current review covers the current literature and practice patterns of antimicrobial therapy for contact lens-related microbial keratitis (CLMK). Although the majority of corneal ulcers are bacterial, fungus and acanthamoeba are substantial contributors in CLMK and are harder to treat due to the lack of commercially available topical medications and low efficacy of available topical therapy.Recent findingsTopical antimicrobials remain the mainstay of therapy for corneal ulcers. Fluoroquinolones may be used as monotherapy for small, peripheral bacterial ulcers. Antibiotic resistance is a persistent problem. Fungal ulcers are less responsive to topical medications and adjunct oral or intrastromal antifungal medications may be helpful. Acanthamoeba keratitis continues to remain a therapeutic challenge but newer antifungal and antiparasitic agents may be helpful adjuncts. Other novel and innovative therapies are being studied currently and show promise.SummaryContact lens-associated microbial keratitis is a significant health issue that can cause vision loss. Treatment remains a challenge but many promising diagnostics and procedures are in the pipeline and offer hope.

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