This article is more than 5 years old. Information may no longer be current.
Study investigates risk factors for poor outcomes of Acanthamoeba keratitis
Click Here to Manage Email Alerts
A retrospective audit of medical records over a period of 20 years at the Moorfields Eye Hospital gave useful insights on risk factors for poor outcomes and severe inflammatory complications in eyes with Acanthamoeba keratitis.
Records were collected for 194 eyes of 194 affected patients, 93 of which (48%) had poor outcomes, defined as having one or more of the following features: corneal perforation, keratoplasty, other ocular surgeries, duration of antiamoebic therapy (AAT) of 10.5 months or more and a final visual acuity of 20/80 or less. Severe inflammatory complications included scleritis and/or corneal stromal ring infiltrates.
Age older than 34 years and the use of corticosteroids before AAT turned out to be significant risk factors for both poor outcome and severe inflammatory conditions (SICs). More advanced disease was also a risk factor for poor outcome, and the development of SICs was significantly associated with treatment for herpes simplex virus (HSV) keratitis treatment before AAT.
According to the authors, the association of both poor outcomes and SICS with older age may be related with impoverished host defenses. Delayed treatment and previous treatment with steroids, on the other hand, may predispose the patient to an increase in the quantity and distribution of Acanthamoeba in the cornea, making the disease more difficult to treat. Finally, the increased rate of SICs in eyes previously treated for HSV keratitis may be due to an altered immune response of the cornea after treatment with acyclovir.
“This analysis of risk factors for bad outcomes and SICs adds to the existing evidence that delayed diagnosis, misdiagnosis of AK as HSV keratitis and topical corticosteroid use before AAT are avoidable risk factors for bad outcomes,” the authors wrote. – by Michela Cimberle
Disclosure: The authors reported no relevant financial disclosures.
Click Here to Manage Email Alerts