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Br J Ophthalmol. 2018 Oct;102(10):1431-1435. doi: 10.1136/bjophthalmol-2017-310806. Epub 2018 Jan 3.

Acanthamoeba keratitis in 194 patients: risk factors for bad outcomes and severe inflammatory complications.

Author information

1
School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia.
2
Centre for Vision Research, The Westmead Institute for Medical Research, Westmead, New South Wales, Australia.
3
Moorfields Eye Hospital NHS Foundation Trust, London, UK.
4
University of Sydney, Sydney, New South Wales, Australia.
5
EpiVision Ophthalmic Epidemiology Consultants, London, UK.
6
National Institute of Health Research (NIHR) Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.

Abstract

BACKGROUND/AIMS:

To determine demographic and clinical features of patients with Acanthamoeba keratitis (AK) that are independent risk factors both for bad outcomes and for severe inflammatory complications (SIC).

METHODS:

A retrospective audit of medical records of AK cases at Moorfields Eye Hospital from July 2000 to April 2012, including 12 earlier surgical cases. Cases with a bad outcome were defined as those having one or more of the following: corneal perforation, keratoplasty, other surgery (except biopsy), duration of antiamoebic therapy (AAT) ≥10.5 months (the 75th percentile of the whole cohort) and final visual acuity ≤20/80. SICs were defined as having scleritis and/or a stromal ring infiltrate. Multivariable analysis was used to identify independent risk factors for both bad outcomes and SICs.

RESULTS:

Records of 194 eyes (194 patients) were included, having bad outcomes in 93 (48%). Bad outcomes were associated with the presence of SIC, aged >34 years, corticosteroids used before giving AAT and symptom duration >37 days before AAT. The development of SIC was independently associated with aged >34 years, corticosteroids used before giving AAT and herpes simplex virus (HSV) keratitis treatment before AAT.

CONCLUSIONS:

The prompt diagnosis of AK, avoidance of a misdiagnosis of HSV keratitis and corticosteroid use before the exclusion of AK as a potential cause of keratitis are essential to the provision of a good outcome for patients and for the avoidance of SIC. Older age is an unmodifiable risk factor that may reflect differences in the immune response to AK in this patient subset.

KEYWORDS:

contact lens; cornea; epidemiology; infection; inflammation

[Indexed for MEDLINE]

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