September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Acanthamoeba Keratitis (AK): Presentation, Diagnosis and Management in a cohort of 43 patients
Author Affiliations & Notes
  • Umiya Agraval
    Gartnavel General Hospital , Tennent Institute of Ophthalmology, Glasgow, United Kingdom
  • Lona Jawaheer
    Gartnavel General Hospital , Tennent Institute of Ophthalmology, Glasgow, United Kingdom
  • Dilys Oladiwura
    Gartnavel General Hospital , Tennent Institute of Ophthalmology, Glasgow, United Kingdom
  • Sanjay Mantry
    Gartnavel General Hospital , Tennent Institute of Ophthalmology, Glasgow, United Kingdom
  • Elisabeth MacDonald
    Gartnavel General Hospital , Tennent Institute of Ophthalmology, Glasgow, United Kingdom
  • Kanna Ramaesh
    Gartnavel General Hospital , Tennent Institute of Ophthalmology, Glasgow, United Kingdom
  • Claire L Alexander
    Gartnavel General Hospital , Tennent Institute of Ophthalmology, Glasgow, United Kingdom
  • Deepa Anijeet
    Gartnavel General Hospital , Tennent Institute of Ophthalmology, Glasgow, United Kingdom
  • Footnotes
    Commercial Relationships   Umiya Agraval, None; Lona Jawaheer, None; Dilys Oladiwura, None; Sanjay Mantry, None; Elisabeth MacDonald, None; Kanna Ramaesh, None; Claire Alexander, None; Deepa Anijeet, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 6202. doi:
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      Umiya Agraval, Lona Jawaheer, Dilys Oladiwura, Sanjay Mantry, Elisabeth MacDonald, Kanna Ramaesh, Claire L Alexander, Deepa Anijeet; Acanthamoeba Keratitis (AK): Presentation, Diagnosis and Management in a cohort of 43 patients. Invest. Ophthalmol. Vis. Sci. 2016;57(12):6202.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : The diagnosis of acanthamoeba keratitis (AK) can be elusive, leading to initiation of inappropriate treatment and adverse visual outcomes. This retrospective study looks at the diagnosis, management and outcomes of AK

Methods : 43 patients who were diagnosed with AK since 2009 were included in this study (minimum follow up 3 months). Data collected included demographics, use of contact lens (CL), signs and symptoms and stage at presentation (i.e. early: epitheliopathy, radial keratopathy; or late: stromal infiltrates, ulceration, anterior uveitis), initial and final visual acuities (VA) and use of topical steroids prior to diagnosis. We also looked at the diagnostic method/s employed (corneal scrape, corneal biopsy, confocal microscopy, polymerase chain reaction (PCR) and treatment given.

Results : There were 43 patients (16 males). Age ranged from 18 to 72 years (median 36). 1 was a non-contact lens wearer. Types of CL used were mostly soft monthly disposable (37.2%) and soft daily disposable (25.6%) lenses.. Clinically 39.5% had early while 60.5% had late features. Diagnostic methods included corneal scrape (88.4%), confocal microscopy (41.9%), and corneal biopsy (16.3%). PCR testing was carried out from scrapes/tear film/CL fluid in 74.4% of cases. The highest rates of diagnosis were from PCR from corneal scrape (85.7%) and confocal microscopy (72.2%). Only 10.5% of cultures were positive. A clinical diagnosis was made in 3 cases.
Initial treatment was with topical antiacanthamoeba agents (chlorhexidine/hexamidine in 55.8%, PHMB/hexamidine in 14.0%). 12 patients were started on topical steroids prior to diagnosis of AK – 27.3% of patient in the steroid group had a visual outcome of logmar 1 or worse (compared to 10.7% in non steroid group). 45.5% of patients in the steroid group had a visual outcome of 0.0 or better (64.3% in non steroid group). Initial early-stage VA range was 0.0-0.8, late-stage VA (0.2-2.7); final early-stage VA range was -0.1 – 0.5, late 0.0-2.3. 3 patients needed a corneal transplant.

Conclusions : Early diagnosis of AK has a better visual prognosis. Our study found that PCR has the highest sensitivity for diagnosis of AK. Patients started on topical steroids prior to the diagnosis of AK had poorer visual outcomes.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

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