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Kornelia Lenke Laurik, Nóra Szentmáry, Loay Daas, Achim Langenbucher, Berthold Seitz; Penetrating keratoplasty à chaud in acute acanthamoeba keratitis. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1234.
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© ARVO (1962-2015); The Authors (2016-present)
Acanthamoeba keratitis (AK) is still a diagnostic and therapeutic challenge in modern ophthalmology. Recent literature data suggests that the surgical treatment should be postponed to approximately 3 months after the active interval of the disease. The purpose of this study was to present our results of emergency penetrating keratoplasty (PKP à chaud) in therapy-resistant cases and to investigate the impact of early surgical treatment on graft survival and functional outcome.
Twenty-eight eyes of 27 patients were treated for acute AK at the Department of Ophthalmology, Saarland University Medical Center between 2006 and 2015. In 23 eyes of 23 patients (mean age 39.6±13.3 years), we performed 1 PKP (18 eyes), 2 PKPs (3 eyes) and 3 PKPs (2 eyes). In each case simultaneous intraoperative corneal cryotherapy was applied. Half of the first PKPs were performed not more than 2 weeks after the first examination at our Department with an overall preoperative course of the disease varying from 2 weeks to 3 years (median 5.3 months). We performed a riboflavin-UVA-crosslinking in 13 eyes, 11.2 ± 12.4 days prior to PKP. Eyes were grouped into preoperative course of the disease less than 5 (group 1) and greater than or equal to 5 months (group 2).
After an average follow-up of 22.7 ± 18.5 months 17 grafts remained clear (13 after single PKP, 4 after multiple PKPs). The best corrected logMAR visual acuity varied from NLP to 0.0 (median 0.5). Thirty-four amniotic membrane patches were applied to treat persisting epithelial defects post-PKP. In 4 cases of group 2 no epithelial healing could be reached and 5 grafts failed. One eye with a visual acuity of NLP was enucleated. In group 1 all grafts remained clear and the epithelium recovered completely. The mean best corrected visual acuity in group 1 (logMAR 0.33 ± 0.16) was significantly better compared to group 2 (logMAR 1.23 ± 0.88; p=0.048).
Our results suggest that the preoperative course of the disease may significantly influence the success rate of graft survival as well as the visual acuity post-PKP in AK. Thus, early penetrating keratoplasty à chaud in the acute phase might be a valuable treatment alternative. However, a specific topical treatment up to one year seems to be indispensable in order to prevent recurrence.
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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