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K. Yamazoe, Y. Yamamoto, K. Hotta, J. Shimazaki; Factors Affecting Visual Outcome in Acanthamoeba Keratitis Treated With Topical Chlorhexidine Gluconate. Invest. Ophthalmol. Vis. Sci. 2010;51(13):2892.
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To identify prognostic factors affecting visual outcome in acanthamoeba keratitis (AK) that were treated with topical chlorhexidine gluconate.
Consecutive 27 eyes of 27 patients with AK were treated with topical 0.02% chlorhexidine gluconate. Many of them also had corneal scraping and antifungal eyedrops. The diagnosis was made based on positive culture results (16 eyes) or clinical characteristics (11 eyes). They were divided into 2 groups according to the final visual outcome; final vision 20/25 or better 17 eyes, Group 1), and vision worse than 20/25 (10 eyes, Group 2). We compared these groups to determine the clinical and demographic factors affecting the outcome.
All patients used contact lenses. There were no differences in either age, gender, diagnosis at presentation, or positive culture rate between the two groups. A ring infiltrate was only seen in the Group 2 (P<0.001), whereas pseudodendritic lesions was only seen in the Group 1 (P=0.057). Duration between the onset and diagnosis was significantly longer (P=0.044) and visual acuity at first examination was significantly worse (P=0.002) in the Group 2. Keratoplasty was performed in 3 eyes in the Group 2 for optical improvements, and all of them achieved visual acuity 20/30 or better postoperatively.
Duration between the onset and diagnosis, visual acuity at first examination and ring infiltrates were predictive factors for the final visual outcome in AK. In cases with poor visual outcome, keratoplasty at the appropriate timing may be a good option for visual rehabilitation. Topical chlorhexidine gluconate seemed to be comparably effective with other treatments.
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