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Therapeutic keratoplasty effective for medically unresponsive Acanthamoeba keratitis
Ophthalmology. 2009;116(5):864-869.
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Therapeutic keratoplasty proved effective in treating eyes with Acanthamoeba keratitis. However, it required more revisions than optical keratoplasty.
“Although it is desirable to defer keratoplasty whenever possible in eyes with active Acanthamoeba keratitis to ensure the best possible prognosis of graft survival and visual acuity, it is important to be cognizant of the value of [therapeutic keratoplasty] in achieving a microbiological cure in medically unresponsive cases,” the study authors said.
The retrospective case review included 22 eyes of 22 patients that underwent therapeutic keratoplasty and nine eyes of eight patients that underwent optical keratoplasty.
The therapeutic keratoplasty patients had a mean age of 40 years; optical keratoplasty patients had a mean age of 30 years. More eyes treated with therapeutic keratoplasty had contact lens wear as a risk factor for Acanthamoeba keratitis (82%) than eyes treated with optical keratoplasty (67%). Therapeutic keratoplasty eyes also had a higher incidence of ring infiltrate, corneal thinning and hypopyon, the authors said.
Of eyes that underwent therapeutic keratoplasty, 12 required repeat keratoplasties. One eye in the optical keratoplasty group required repeat keratoplasty. Therapeutic keratoplasty eyes had a median visual acuity of 20/40; optical keratoplasty eyes had a median visual acuity of 20/25. Therapeutic keratoplasty eyes had a mean graft survival rate of 45.5% at 1 year; optical keratoplasty grafts had a mean 1-year survival rate of 100%, the authors said.
However, a microbiological cure was attained in all eyes, they said.