Abstract
Purpose :
The use of in vivo confocal microscopy (IVCM) in the diagnosis of acanthamoeba keratitis (AK) is well known, however, information pertaining to its practical use in short- and long-term management of AK patients is less well documented. Here we describe how IVCM contributed to the management of AK cases at an IVCM referral center during a 12-year period.
Methods :
All referred and local cases with suspected or confirmed AK during 2010-2022 with an available IVCM examination were included in this retrospective study. Patient demographics, clinical characteristics, management and outcomes were analyzed. IVCM images during the course of treatment were also analyzed.
Results :
74 patients were included in the study, and consisted of subgroups of patients who were referred for a second opinion/IVCM confirmation (11%), those who were detected positive for AK by IVCM (24%), those who were negative for AK by IVCM (44%), and those with inconclusive results (20%). Cultures were taken in only 51% of cases due to confirmed AK by other methods, response to medications or being sent back to the home clinic. Culture results were positive for AK in only 2 cases, however, 18 cases were AK-positive by IVCM. Median days of care for all subjects was 233, with IVCM-negative cases having the shortest clinical course and IVCM-positive cases having the longest, typically extending up to several years and 20-30 clinic visits. Over half of the AK-positive cases required surgical intervention in addition to pharmacologic treatment, and 2 eviscerations were recorded. 78% of patients had 3 or more IVCM examinations during follow-up, which revealed dynamic changes in cysts, nerves and inflammation, aiding in patient management.
Conclusions :
The management of AK with IVCM is more complex than a single positive or negative diagnostic result and represents a long-term coordinated management of patients and collaboration with referring clinics. Various diagnostic methods have advantages and drawbacks and the use of these methods is dictated by the information available to the clinician. IVCM can be useful in several respects, including providing a second opinion, confirmation of positive or negative AK status, continued monitoring and prognosis during the follow-up period, and determining which patients are most likely to have quick keratitis resolution.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.