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K. M. Hammersmith, H. F. Chew, R. C. Eagle, Jr., C. J. Rapuano, B. D. Ayres, P. R. Laibson, E. J. Cohen; The Continued Rise of Acanthamoeba Keratitis. Invest. Ophthalmol. Vis. Sci. 2008;49(13):503.
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© ARVO (1962-2015); The Authors (2016-present)
To update the continued increase of Acanthamoeba keratitis (AK) recently diagnosed at Wills Eye Institute from 2006 to 2007. To verify the risk factors, clinical characteristics, treatments and outcomes of patients with AK.
Retrospective consecutive case series of 24 eyes with AK.
Twenty-four patients were diagnosed with AK: ten patients in all of 2006 and 14 patients in 2007. One patient did not wear contact lenses, while 23 patients wore frequent replacement contact lenses. All 23 frequent replacement soft contact lens wearers used one-step multipurpose cleaning solutions (MPS). Twelve (50%) used Complete® MoisturePlus (AMO, Santa Ana, CA); three (12.5%) used Renu® (B&L, Rochester, NY); three (12.5%) used Opti-Free® (Alcon, Fort Worth, TX); four (17%) used an unknown/generic MPS. From Jan. 1, 2006 to May 31, 2007, there were 12 cases of AK, and five of these cases used Complete® MoisturePlus. After June 1, 2007, there were another 12 cases of which seven used Complete® MoisturePlus. Ten patients (42%) swam in their lenses. Nine patients (38%) were exposed to well water. Mean time to diagnosis was 28 days (range: 4-90; SD=23.4). Herpes simplex keratitis was misdiagnosed in 15 cases (63%). Topical steroids were used in 17 cases (71%) prior to diagnosis of AK. High intraocular pressures developed in 7 (29%) patients. Narcotic medication was required by 22 of the 24 patients (92%). Fourteen cases (58%) were diagnosed by histopathology, 9 cases (37.5%) by clinical examination and response to treatment, and one (4%) by corneal biopsy.
There is a continued increase in the incidence of AK at our institution (Ref: Thebpatiphat N. et al. Acanthamoeba Keratitis a Parasite on the Rise. Cornea 2007;26;701-706). The risk factors for AK are multifactorial. AK remains a diagnostic challenge. Despite the voluntary recall of Complete® MoisturePlus, AK with this and other MPS still occurs.
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