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N. Thebpatiphat, K.M. Hammersmith, F.N. Rocha, B.D. Ayres, C.J. Rapuano, E.J. Cohen; Acanthameoba Keratitis at Wills Eye Hospital: A Parasite on the Rise . Invest. Ophthalmol. Vis. Sci. 2006;47(13):3568.
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To report a recent, dramatic increase incidence of patients diagnosed acanthameoba keratitis at Wills Eye Hospital (WEH) between Jan. 2004 to Nov.2005. To determine the risk factors, clinical characteristics, treatments and outcomes of patients with acanthameoba keratitis.
This retrospective review comprised of 20 patients with acanthameoba keratitis at WEH from Jan. 2004 to Nov. 2005.The diagnosis was made by pathology, microbiology and clinical methods. The collected information included initial and final BCVA at 3 months follow up(F/U), risk factors ;contact lenses (CL) history, history of swimming with CL, exposure to well water and/or hot tub; clinical characteristics, methods of diagnosis and treatments.
A statistically significant increased incidence was seen in 2004 and 2005 when compared with cases from 1995 to 2003 (P<0.01). All cases wore CL, 19/20(95%) wore frequent replacement soft CL and used multipurpose solutions and 1/20(5%) wore RGP. Other risk factors were exposure to well water in 8/20(40%) and swimming with CL in 5/20(25%).The diagnosis was made by pathology in 10/20(50%), by microbiology in 3/20(15%) and by classic characteristics 7/20(35%). Herpes simplex was the previous misdiagnosis in 14/20(70%).Average duration of completed treatment was 144 days. At 3 months F/U, the epithelial or radial keratitis had BCVA better than 0.18 LogMAR in 5/7(71%) and the ring or stromal diseases had BCVA less than 1 LogMAR in 5/10(50%).
We observed an increased incidence of acanthameoba keratitis. Acanthameoba keratitis is often mistaken for HSV. Advanced stromal disease at diagnosis is associated with worse outcome.
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