The Clinical Experience of Acanthamoeba Keratitis at a Tertiary Care Eye Hospital

Abstract

The number of AK cases at the Massachusetts Eye and Ear Infirmary has increased since 2004. Contact lens wear and exposure to contaminated water sources were potential risk factors for AK. Clinicians should maintain a high clinical suspicion for AK in cases of atypical keratitis with known risk factors for AK.

Acanthamoeba Keratitis: Clinical Characteristics and Management

“…Similarly, 53% of AK patients at a tertiary care eye hospital in USA required therapeutic grafts. 8 However, the prognosis of penetrating keratoplasty for AK remains poor. 15 It is interesting that in some patients AK improved at the beginning of treatment, then worsened, and then improved gradually.…”

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

“…1 Acanthamoeba keratitis (AK) was first reported in 1974, and several outbreaks have been reported worldwide in recent years. [2][3][4][5][6] This contact lens-related keratitis is difficult to diagnose and treat because symptoms are often nonspecific and classic signs are not always present. Delay in proper diagnosis has been correlated with more extensive disease at the time of presentation, greater likelihood of requiring therapeutic penetrating keratoplasty (PK), and worse final visual acuity (VA).…”

“…Delay in proper diagnosis has been correlated with more extensive disease at the time of presentation, greater likelihood of requiring therapeutic penetrating keratoplasty (PK), and worse final visual acuity (VA). [3][4][5][6][7] Moreover, medical treatment is often complicated by several factors, including the resistance of Acanthamoeba spp. cysts to many pharmacological agents and the use of topical steroids before diagnosis.…”

Keratoplasty in Contact Lens Related Acanthamoeba Keratitis

“…Many of these eyes will be severely inflamed with uncontrolled scleritis and limbitis, which should be treated before surgery with systemic immunsuppression using prednisolone (0.5 to 1 mg/kg/day) and/or cyclosporine (3 to 7.5 mg/kg/day), which is tapered as inflammation is controlled in the post graft period (Dart et al 2009;Maier et al, 2007). Performing PK before scleral or peripheral corneal extension can minimize the risk of recurrence and poor outcome (Nguyen et al, 2010;Tanhehco & Colby, 2010).…”

“…Planned replacement of contact lens storage cases may also help reduce contamination. It is important for eye care professionals not only to emphasize proper contact lens wear and hygiene in the prevention of infectious keratitis but also to maintain a high clinical suspicion for Acanthamoeba keratitis because an early diagnosis may lead to a better visual outcome (Tanhehco & Colby, 2010). The use of surfactant cleaner has been shown to be an effective way of removing Acanthamoeba trophozoites and cysts (Kilvington, 1993).…”