Abstract
Abstract: :
Purpose: To provide the first description of the association of acanthamoeba keratitis (AK) and glaucoma, establish an incidence of glaucoma in AK patients, discuss treatment options and outcomes in these patients, and describe the histopathologic findings and pathogenesis of glaucoma secondary to AK. Methods: Following IRB approval, the charts of all patients suspected of having AK (received confocal microscopy [2000 – present], prescribed topical Brolene [2001 – present], or were listed on an AK registry [1994 – present]) at Aston Ambulatory Center at University of Texas Southwestern Medical Center were reviewed. Inclusion criteria were: diagnosis of AK with either positive confocal microscopy or culture, diagnosis of glaucoma/ocular hypertension secondary to AK, and at least 6 months follow up. Exclusion criteria included: previous diagnosis of glaucoma/ocular hypertension, and any history of intraocular surgery prior to developing glaucoma. Date of keratitis development, pneumotonometry on the initial and follow up exams, glaucoma medications used, and surgical procedures performed were tabulated. Results: 20 patients (20 eyes) were included. 7 eyes (35%) developed secondary glaucoma during the period under review. Of the patients treated for glaucoma with medication alone, 4 out of 5 (80%) became LP or NLP. 3 out of 7 patients required glaucoma drainage tube implantation for pressure control. Of these, 1 eye became NLP, while the other 2 maintained better than 20/100 vision. Histopathologic examination revealed chronic inflammation of the trabecular meshwork and angle closure. No acanthamoeba organisms were found in the angle structures. Conclusions: Secondary glaucoma is not uncommon in AK. The development of secondary glaucoma is a poor prognostic sign in patients with AK as the majority progress to LP or NLP vision. Histopathologic findings suggest an inflammatory angle closure mechanism, apparently without direct infiltration of the organism. Finally, the glaucoma associated with AK is often severe and frequently requires surgical intervention for pressure control and visual preservation.
Keywords: Acanthamoeba • intraocular pressure • keratitis