April 2014
Volume 55, Issue 13
Free
ARVO Annual Meeting Abstract  |   April 2014
Topical steroid use prior to diagnosis exacerbates Acanthamoeba keratitis.
Author Affiliations & Notes
  • Nicole Ann Carnt
    Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
    Institute of Ophthalmology, University College London, London, United Kingdom
  • Dana Robaei
    Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
  • Darwin Minassian
    EpiVision Ophthalmic Epidemiological Consultants, London, United Kingdom
  • John Kenneth George Dart
    Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
    Institute of Ophthalmology, University College London, London, United Kingdom
  • Footnotes
    Commercial Relationships Nicole Carnt, CooperVision, Alcon (C); Dana Robaei, None; Darwin Minassian, None; John Dart, SIFI Pharmaceuticals (C)
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science April 2014, Vol.55, 5466. doi:https://doi.org/
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    • Get Citation

      Nicole Ann Carnt, Dana Robaei, Darwin Minassian, John Kenneth George Dart; Topical steroid use prior to diagnosis exacerbates Acanthamoeba keratitis.. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5466. doi: https://doi.org/.

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

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Abstract
 
Purpose
 

To determine the impact of topical corticosteroid use, before the diagnosis of Acanthamoeba keratitis (AK), on visual outcomes.

 
Methods
 

A medical record review of patients diagnosed with Acanthamoeba keratitis at Moorfields Eye Hospital, London between January 1991 and April 2012 was conducted. Patient demographics, clinical findings and management details were collected. Suboptimal visual outcome was defined as final visual acuity ≤ 20/80, corneal perforation, or need for keratoplasty. For bilateral cases, one eye was randomly excluded from analysis. A multivariate logistic regression model, optimized for the use of steroids prior to diagnosis, was used to generate odds ratios for a suboptimal visual outcome.

 
Results
 

Data for 209 eyes of 196 patients were available. AK was diagnosed with culture (94 eyes, 48.0%), histopathology (27 eyes, 13.8%), confocal microscopy (38 eyes, 19.4%) or a typical clinical course and treatment response (37 eyes, 18.9%). Information on visual outcomes and prior steroid use was available for 174 eyes (88.8%). In multivariate analysis, prior steroid use was associated with poorer vision (odds ratio, OR 3.90; 95% confidence interval, CI, 1.78-8.55). Additional independent risk factors for poorer visual outcomes were older age (60+, (OR 8.97; 95% CI 2.13-37.79) and late stage disease at presentation (OR 5.62; 95% CI 1.59-19.80).

 
Conclusions
 

Steroid use prior to the diagnosis of AK, most often due to the misdiagnosis of herpetic keratitis, is predictive for a suboptimal visual outcome. Incorporating AK in the differential diagnosis of suspected herpetic keratitis is essential, particularly in contact lens wearers, in older individuals and in those presenting with progressive/indolent keratitis. Topical steroid use should be avoided until Acanthamoeba has been excluded. Accurate diagnosis requires culture, PCR and confocal microscopy.

 
 
Pseudodendritic epitheliopathy in early Acanthamoeba keratitis.
 
Pseudodendritic epitheliopathy in early Acanthamoeba keratitis.
 
Keywords: 402 Acanthamoeba • 487 corticosteroids • 462 clinical (human) or epidemiologic studies: outcomes/complications  
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