Prognostic Factors Associated With the Need for Surgical Treatments in Acanthamoeba Keratitis

Bouheraoua, Nacim; Gaujoux, T.; Goldschmidt, Pablo; Chaumeil, C.; Laroche, L.; Borderie, Vincent

doi:10.1097/ico.0b013e31826429bd

Cited by 36 publications

(31 citation statements)

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“…is also known for inducing a form of keratitis unresponsive to topical drugs, thus requiring a therapeutic transplant. 3,6,7,9,10 Deep anterior lamellar keratoplasty (DALK) is the surgical procedure that most suits corneal diseases affecting the stroma and sparing the endothelium. Preserving this layer provides the benefits of less risk of rejection and graft failure, when compared with PK.…”

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confidence: 99%

Early Deep Anterior Lamellar Keratoplasty (DALK) for Acanthamoeba Keratitis Poorly Responsive to Medical Treatment

Sarnicola

Sabatino

et al. 2016

Cornea

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confidence: 99%

Early Deep Anterior Lamellar Keratoplasty (DALK) for Acanthamoeba Keratitis Poorly Responsive to Medical Treatment

Sarnicola

Sabatino

et al. 2016

Cornea

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“…Recognition of signs and symptoms indicative of best/worst prognosis [23,24] Monotherapy with a biguanide or combined therapy using biguanides and diamidines with adjustable therapeutic regimen is effective in several cases, leading to a best outcome [4,25,27]. Ocular toxicity of current anti-Acanthamoeba drugs [4,47,48,49] Proof of efficacy of off-label drugs [50,51] or novel anti-Acanthamoeba compounds previously approved in pre-clinical trials.…”

Section: Ak Patientmentioning

confidence: 99%

“…From a series of clinical reports, identification of the signs and symptoms associated with a poor prognosis [22][23][24] is a starting point. In addition, analysis of differential therapeutic responses among individual case descriptions, retrospective or prospective epidemiological surveys and clinical trials can contribute to direct the management of disease and decide about the treatments with the greatest chance of success in different situations [2,[25][26][27].…”

Section: Reverse Translational Researchmentioning

confidence: 99%

“…Radial keratoneuritis and ring infiltrates as characteristic signs [4,22,24] Recognition of signs and symptoms for accurate diagnosis. Recognition of signs and symptoms indicative of best/worst prognosis [23,24] Monotherapy with a biguanide or combined therapy using biguanides and diamidines with adjustable therapeutic regimen is effective in several cases, leading to a best outcome [4,25,27].…”

Section: Ak Patientmentioning

confidence: 99%

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Translational and Reverse Translational Research Supporting Precision Medicine: Acanthamoeba Keratitis as a Model of Linkage between Clinical and Basic Research Focused on Personalized Ophthalmology

Carvalho¹

2014

OCR

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Translational Research is defined as Scientific Research conducted in order to apply discoveries from basic sciences for developing new applications to improve clinical practice and patient's welfare, including rapid, specific and sensitive diagnostic methods, and safely effective therapeutic agents. The translational approach "from bench to bedside" has limited success if there is not a reverse path. Reverse translational research ensures the feedback "from bedside to bench" and helps identifying specific subjects that demand laboratory investigation or establishing inferences between laboratory findings and clinical observations. Precision medicine employs scientific advances and discoveries from basic sciences on the clinical research to provide an accurate diagnosis followed by a personalized care for each patient, selecting the most suitable therapy pattern for a specific etiology. In the genomic era, a full and integrative cycle between these three areas of translation is now possible. Management of knowledge concerning the application of molecular biology, biochemistry and cellular technologies can offer personalized application of basic sciences' tools within a specific sub-specialty of ophthalmology. Advanced basic science supported by current omics technologies provides a potential linkage between the standardized experimental data-from in vitro and in vivo assays under controlled laboratorial environment and the applied science used in clinical routine. The linkage between both basic and applied sciences focuses on the improvement of human health. The three main aspects of cyclic interaction constituted by the two-way approaches between bench top and bedside with main focus on the application of precision medicine to provide knowledge about human diseases are illustrated here with examples in the context of Acanthamoeba keratitis. This paper presents translational approaches in the ophthalmology field and visual sciences, available technologies, and promising issues to be investigated through reverse translational research, such as searching for specific biomarkers, setting up prognostic factors and recognizing differential profiles of host resistance and pathogen virulence. These advances may render benefits for the practice of personalized medicine. Fábio Ramos de Souza Carvalho*, Linda Christian Carrijo-Carvalho and Denise de Freitas

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“…Most studies involving epidemiology, clinical course, and prognosis in ocular amoebiasis do not look into genotypes (23)(24)(25)(26). The few clinical studies that include routine genotyping of all AK cases have revealed that genotype T4 is the only cause of pathogenic AK isolated from corneal exudates or have found a single case of non-T4 genotype in their case series (11,27).…”

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Influence of Acanthamoeba Genotype on Clinical Course and Outcomes for Patients with Acanthamoeba Keratitis in Spain

et al. 2014

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Genotype T4 is by far the most frequent genotype of Acanthamoeba keratitis (AK) and therefore has been considered the most virulent. This study included 14 cases of AK of genotype T4 and three cases of non-T4 genotype. We found that cases of non-T4 genotype had a worse response to medical therapy, greater need for surgical intervention, greater risk of extracorneal involvement, and remarkably poorer final visual outcome than those of T4 genotype, suggesting an association between Acanthamoeba virulence and genotype that requires additional case investigation.A canthamoeba keratitis (AK) is a potentially blinding corneal infection in healthy immunocompetent individuals and is caused by free-living amoebae of the genus Acanthamoeba (1). Analysis of the 18S rRNA gene has identified 18 genotypes (T1 through T18) within this genus (2-4). Isolates from eight of the genotypic clades (T2, T3, T4, T5, T6, T10, T11, and T15) are confirmed causative agents of AK (4-12). Disease severity can range from relatively minor epithelial and subepithelial diseases, which respond well to treatment, to refractory disease that can provoke corneal melting and perforation requiring therapeutic or tectonic corneal grafts (13). Currently, the most important factors affecting the prognosis are disease severity at presentation and the interval between symptom onset and the start of effective therapy (14, 15); beginning therapy Ͼ3 weeks after symptom onset is associated with a worse prognosis.This study aimed to identify the genotypes of Acanthamoeba isolates from AK patients at our institution and to find any association between genotype and clinical outcomes.This revision was approved by the institutional review board at Hospital Universitario Ramón y Cajal. Seventeen amoebal isolates were obtained from the eyes of 17 patients with a clinical diagnosis of AK and who were followed prospectively at Hospital Universitario Ramón y Cajal, Madrid, Spain, from July 2009 to July 2013. The best spectacle-corrected visual acuity (BSCVA) in decimal Snellen fraction notation (1.0 indicates a normal value, and 0 indicates no vision at all), slit lamp and fundus examinations, and other events were recorded in the clinical notes. Tissue was obtained from each patient by epitheliectomy or by scraping the corneal ulcer when there was no epithelium left. A portion of the sample was routinely plated in blood agar, thioglycolate broth, or Sabouraud agar to rule out bacterial or fungal infection. The rest of the sample was submerged in a microcentrifuge tube with saline and sent together with the patient's contact lenses and cases to the laboratory at the University Institute of Tropical Diseases and Public Health of the Canary Islands; there it was cultured on 2% nonnutrient agar (NNA) plates and examined using an inverted microscope as previously described (16). Lenses were directly cultured in NNA and checked for amoebic growth. The contact lens cases were washed twice with 2 ml of sterile saline, and the saline was then filtered using a vacuum manifold sys...

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Prognostic Factors Associated With the Need for Surgical Treatments in Acanthamoeba Keratitis

Abstract: Late diagnosis, low initial visual acuity, corneal neovascularization, large infiltrates, and preperforated infiltrates were associated with surgical treatment in patients presenting with AK. Surgical intervention was associated with worse visual outcome.

Cited by 36 publications

References 36 publications

Early Deep Anterior Lamellar Keratoplasty (DALK) for Acanthamoeba Keratitis Poorly Responsive to Medical Treatment

Early Deep Anterior Lamellar Keratoplasty (DALK) for Acanthamoeba Keratitis Poorly Responsive to Medical Treatment

Translational and Reverse Translational Research Supporting Precision Medicine: Acanthamoeba Keratitis as a Model of Linkage between Clinical and Basic Research Focused on Personalized Ophthalmology

Influence of Acanthamoeba Genotype on Clinical Course and Outcomes for Patients with Acanthamoeba Keratitis in Spain

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