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Jane Huang, Hiroaki Ozaki, Naoyasu Umeda, Aki Fuchigami, Masahiko Kozawa, Eiichi Uchio; Clinical outcomes and prognostic factors associated with Acanthamoeba keratitis treated with pentamidine isethionate. Invest. Ophthalmol. Vis. Sci. 2013;54(15):879.
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To describe the clinical characterics, time of presentation, risk factors, treatment, outcomes, and prognostic factors on a series of Acanthamoeba keratits (AK) treated with pentamidine isethionate at our institution. This is also a first report on a series of AK cases treated with pentamidine isethionate.
Retrospective study of 24 patients 26 eyes diagnosed with AK from April 1, 2006 to November 19, 2012. All eyes underwent adjunctive treatment with pentamidine isethionate and had a complete follow-up data. A review of all patients including gender, age, time to diagnosis, use of cortiocosteroid before diagnosis, combination of bacterial or fungal infections, diagnostic method, initial visual acuity, duration of pentamidine isethionate treatment, side effects, and final visual acuity was performed. Treatment failure was defined as AK recurrence or requiring a therapeutic deep anterior lamellar keratoplasty (DALK). Predicting risk factors were analyzed.
Symptom onset was greatest in September. AK was diagnosed by culture or typical clinical presentation of AK. Age ranged from 18 to 64 years old (average 30.0±12.3). The study included 11 women and 13 men and the follow up time was 1 to 60 months (average 13.8±18.6). All were tertiary patients with the time to AK diagnosis ranging from 5 to 60 days (average 21.3±13.0). Forty-two percent of the eyes were previously diagnosed with herpetic keratitis and 58% of the eyes were treated with corticosteroid eye drops. Five eyes had combined bacterial or fungal infections. Twenty-two eyes (84.6%) were contact lens users. Average hospitalization time was 26.9±21.7days. Averaged duration of pentamidine isethionate treatment was 9.8±3.5days and no serious side effects occurred. Visual acuity improved from 1.41logMAR±1.00logMAR to 0.19logMAR±0.34logMAR. Initial clinical manifestation of stromal involvement such as ring infiltration or endothothelial plaque formation was a significant factor for treatment failure.
Symptom onset was greatest in September. Soft contact lens users tend to have a risk of infection and failure is likely to be associated with stromal involvement. The average hospitalization time was 26.9±21.7days. A larger prospective population-based comparative study is required to further confirm the efficacy of pentamidine isethionate.
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