Outcome of therapeutic deep anterior lamellar keratoplasty in advanced Acanthamoeba  keratitis

Bagga, Bhupesh; Garg, Prashant; Joseph, Joveeta; Mohamed, Ashik; Kalra, Paavan

doi:10.4103/ijo.ijo_307_19

Cited by 16 publications

(12 citation statements)

References 22 publications

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“…Most specialists suggest that surgery should not be performed until the acute infection has been alleviated. 46,60 The need for corneal grafting has varied during the past several decades and could be quite high in some studies. Jiang et al 48 stated that 46.7% of their patients required therapeutic grafts.…”

Section: Discussionmentioning

confidence: 99%

Orthokeratology lens-related Acanthamoeba keratitis: case report and analytical review

Xie

2021

J Int Med Res

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Acanthamoeba keratitis (AK) is a rare but severe ocular infection with a significant risk of vision loss. Contact lens use is the main risk factor for AK. The orthokeratology (OK) lens, a specially designed contact lens, has been used worldwide as an effective method of myopia control. However, the OK lens is associated with an increased risk of Acanthamoeba infection. Many primary practitioners are concerned about this infection because of its relative rarity, the lack of promising therapeutic medications, and the need for referral. We herein report two cases of AK associated with OK lenses, present a systematic review of such cases, and discuss the possible reasons for the higher incidence rate of this infection in patients who wear OK lenses. We combined the clinical knowledge and skills of corneal specialists and lens experts with the sole objective of addressing these OK lens-related AK cases. We found that the most common risk factors were rinsing the lenses or lens cases with tap water. Prompt and accurate diagnosis along with adequate amoebicidal treatment are essential to ensure desirable outcomes for OK lens wearers who develop AK. Appropriate OK lens parameters and regular checkups are also important.

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Section: Discussionmentioning

confidence: 99%

Orthokeratology lens-related Acanthamoeba keratitis: case report and analytical review

Xie

2021

J Int Med Res

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“…Recurrence has been noted in the graft host interface post lamellar keratoplasty; however, in cases with the stromal participation alone, a deep anterior lamellar keratoplasty can be attempted with a thorough wash of the interface with antimicrobials intraoperatively. [ 168 169 ] In full-thickness infiltrates, a penetrating keratoplasty with graft size 0.5–1 mm larger than the clinically involved area is recommended as there is always a potential risk of subclinical persistence of organisms near the edges of the lesion, and a postoperative histopathological examination helps confirm whether the disease clearance was adequate. A preoperative ultrasound B-scan is advised to rule out the possibility of endophthalmitis.…”

Section: Antimicrobialsmentioning

confidence: 99%

Update on diagnosis and management of refractory corneal infections

Agarwal

Khan

Vanathi

et al. 2022

Indian Journal of Ophthalmology

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Infectious keratitis is a medical emergency resulting in significant visual morbidity. Indiscriminate use of antimicrobials leading to the emergence of resistant or refractory microorganisms has further worsened the prognosis. Coexisting ocular surface diseases, delay in diagnosis due to inadequate microbiological sample, a slow-growing/virulent organism, or systemic immunosuppressive state all contribute to the refractory response of the ulcer. With improved understanding of these varied ocular and systemic factors contributing to the refractory nature of the microbes, role of biofilm formation and recent research on improving the bioavailability of drugs along with the development of alternative therapies have helped provide the required multidimensional approach to effectively diagnose and manage cases of refractory corneal ulcers and prevent corneal perforations or further dissemination of disease. In this review, we explore the current literature and future directions of the diagnosis and treatment of refractory keratitis.

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“…Treatment failures are frequently reported; these may be attributed to poor penetration of the agent, delay in treatment, insufficient duration of treatment, older age or acquired resistance to the drugs. It has been known that a number of therapeutic agents are not effective at the late stage of infection, especially if the amoebae have invaded tissues beneath the cornea 3,47–51 …”

Section: Prevention and Treatment Of Akmentioning

confidence: 99%

“…It has been known that a number of therapeutic agents are not effective at the late stage of infection, especially if the amoebae have invaded tissues beneath the cornea. 3,[47][48][49][50][51] Other factors contribute to failure in the development of effective chemotherapeutic agents of AK that include vast number of strains with varying degree of virulence traits, the discrepancy between in vitro and in vivo efficacies, and small number of reported AK cases combined with limited interest by the pharmaceutical industry.…”

Section: Prevention and Treatment Of Akmentioning

confidence: 99%

Applications of medicinal chemistry for drug discovery against Acanthamoeba infections

Ahmed

Anwar

Ong

et al. 2021

Medicinal Research Reviews

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Acanthamoeba is a genus of free‐living amoebae, pervasively found in the environment. Most of its pathogenic species are the causative agent of sight‐threatening Acanthamoeba keratitis and fatal granulomatous amoebic encephalitis. Despite the advancements in the field of chemotherapy, treating Acanthamoeba infections is still challenging due to incomplete knowledge of the complicated pathophysiology. In case of infection, the treatment regimen for the patients is often ineffective due to delayed diagnosis, poor specificity, and side‐effects. Besides the resistance of Acanthamoeba cysts to most of the drugs, the recurrence of infection further complicates the recovery. Thus, it is necessary to develop an effective treatment which can eradicate these rare, but serious infections. Based on various computational and in vitro studies, it has been established that the synthetic scaffolds such as heterocyclic compounds may act as potential drug leads for the development of antiamoebic drugs. In this review, we report different classes of synthetic compounds especially heterocyclic compounds which have shown promising results against Acanthamoeba. Moreover, the antiamoebic activities of synthetic compounds with their possible mode of actions against Acanthamoeba, have been summarized and discussed in this review.

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Outcome of therapeutic deep anterior lamellar keratoplasty in advanced Acanthamoeba keratitis

Cited by 16 publications

References 22 publications

Orthokeratology lens-related Acanthamoeba keratitis: case report and analytical review

Orthokeratology lens-related Acanthamoeba keratitis: case report and analytical review

Update on diagnosis and management of refractory corneal infections

Applications of medicinal chemistry for drug discovery against Acanthamoeba infections

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