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Raghavan A, Rammohan R. Acanthamoeba keratitis - A review. Indian J Ophthalmol 2024; 72:473-482. [PMID: 38454853 PMCID: PMC11149514 DOI: 10.4103/ijo.ijo_2627_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/23/2023] [Indexed: 03/09/2024] Open
Abstract
This is a comprehensive review after a thorough literature search in PubMed-indexed journals, incorporating current information on the pathophysiology, clinical features, diagnosis, medical and surgical therapy, as well as outcomes of Acanthamoeba keratitis (AK). AK is a significant cause of ocular morbidity, and early diagnosis with timely institution of appropriate therapy is the key to obtaining good outcomes. The varied presentations result in frequent misdiagnosis, and co-infections can increase the morbidity of the disease. The first line of therapy continues to be biguanides and diamidines, with surgery as a last resort.
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Affiliation(s)
- Anita Raghavan
- Cornea & Refractive Surgery, Department of Microbiology, Aravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
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Qi X, Mao H, Liu J, Dong Y, Du M, Liu T, Zhang T, Lu X, Gao H. Comparison of therapeutic effects between big-bubble deep anterior lamellar keratoplasty and penetrating keratoplasty for medically unresponsive Acanthamoeba keratitis. BMC Infect Dis 2024; 24:276. [PMID: 38438857 PMCID: PMC10910827 DOI: 10.1186/s12879-024-09147-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 02/16/2024] [Indexed: 03/06/2024] Open
Abstract
PURPOSE To compare the outcomes of big-bubble deep anterior lamellar keratoplasty (BB-DALK) and penetrating keratoplasty (PKP) in the management of medically unresponsive Acanthamoeba keratitis (AK). METHODS This retrospective study included 27 eyes of BB-DALK and 24 eyes of PKP from a tertiary ophthalmology care centre. Glucocorticoid eye drops were subsequently added to the treatment plan 2 months postoperatively based on the evaluation using confocal laser scanning microscopy. The clinical presentations, best-corrected visual acuity (BCVA), postoperative refractive outcomes, graft survival, and Acanthamoeba recurrence were analyzed. RESULTS The AK patients included in the study were in stage 2 or stage 3, and the percentage of patients in stage 3 was higher in the PKP group (P = 0.003). Clinical presentations were mainly corneal ulcers and ring infiltrates, and endothelial plaques, hypopyon, uveitis and glaucoma were more common in the PKP group (P = 0.007). The BCVA and the graft survival rate showed no statistically significant differences between the two groups at 1 year after surgery. However, 3 years postoperatively, the BCVA of 0.71 ± 0.64 logMAR, the graft survival rate of 89.5%, and the endothelial cell density of 1899 ± 125 cells per square millimeter in the BB-DALK group were significantly better than those of the PKP group (P = 0.010, 0.046, and 0.032, respectively). 3 eyes (11.1%) in the BB-DALK group and 2 eyes (8.3%) in the PKP group experienced Acanthamoeba recurrence, but the rates showed no statistically significant difference between the two groups (P = 1.000). In the PKP group, immune rejection and elevated intraocular pressure were observed in 5 and 6 eyes, respectively. CONCLUSION Corneal transplantation is recommended for AK patients unresponsive to antiamoebic agents. The visual acuity and graft survival can be maintained after BB-DALK surgery. Acanthamoeba recurrence is not related to the surgical approach performed, whereas complete dissection of the infected corneal stroma and delayed prescribing of glucocorticoid eye drops were important to prevent recurrence.
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Affiliation(s)
- Xiaolin Qi
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Shandong First Medical University, 372 Jingsi Road, Jinan, 250021, China
| | - Huilin Mao
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Shandong First Medical University, 372 Jingsi Road, Jinan, 250021, China
| | - Jinhui Liu
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Shandong First Medical University, 372 Jingsi Road, Jinan, 250021, China
| | - Yanling Dong
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Shandong First Medical University, Jinan, China
| | - Man Du
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Shandong First Medical University, 372 Jingsi Road, Jinan, 250021, China
| | - Ting Liu
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Shandong First Medical University, Jinan, China
| | - Ting Zhang
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Shandong First Medical University, Jinan, China
| | - Xiuhai Lu
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Shandong First Medical University, 372 Jingsi Road, Jinan, 250021, China
| | - Hua Gao
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Shandong First Medical University, 372 Jingsi Road, Jinan, 250021, China.
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Impact of implementation of polymerase chain reaction on diagnosis, treatment, and clinical course of Acanthamoeba keratitis. Graefes Arch Clin Exp Ophthalmol 2023:10.1007/s00417-023-05993-7. [PMID: 36795161 DOI: 10.1007/s00417-023-05993-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 01/24/2023] [Accepted: 01/31/2023] [Indexed: 02/17/2023] Open
Abstract
PURPOSE Acanthamoeba keratitis (AK) is a painful and possibly sight-threatening ocular infection. While the correct diagnosis and specific treatment in the early stages significantly improve the prognosis, the disease is often misdiagnosed and in clinical examination confused with other forms of keratitis. Polymerase chain reaction (PCR) for the detection of AK was first introduced in our institution in December 2013 to improve the timely diagnosis of AK. The aim of this study was to assess the impact of implementation of Acanthamoeba PCR on the diagnosis and treatment of the disease in a German tertiary referral center. PATIENTS AND METHODS Patients treated for Acanthamoeba keratitis between 1st of January 1993 and 31st of December 2021 in the Department of Ophthalmology of the University Hospital Duesseldorf were identified retrospectively via in-house registries. Evaluated parameters include age, sex, initial diagnosis, method of correct diagnosis, duration of symptoms until correct diagnosis, contact lens use, visual acuity, and clinical findings as well as medical and surgical therapy by keratoplasty (pKP). In order to assess the impact of implementation of Acanthamoeba PCR, the cases were divided into two groups (before (pre-PCR group) and after PCR implementation (PCR group). RESULTS Seventy-five patients with Acanthamoeba keratitis were included (69.3% female, median age 37 years). Eighty-four percent (63/75) of all patients were contact lens wearers. Until PCR was available, 58 patients with Acanthamoeba keratitis were diagnosed either clinically (n = 28), by histology (n = 21), culture (n = 6), or confocal microscopy (n = 2) with a median duration until diagnosis of 68 (18; 109) days. After PCR implementation, in 17 patients, the diagnosis was established with PCR in 94% (n = 16) and median duration until diagnosis was significantly shorter with 15 (10; 30.5) days. A longer duration until correct diagnosis correlated with a worse initial visual acuity (p = 0.0019, r = 0.363). The number of pKP performed was significantly lower in the PCR group (5/17; 29.4%) than in the pre-PCR group (35/58; 60.3%) (p = 0.025). CONCLUSIONS The choice of diagnostic method and especially the application of PCR have a significant impact on the time to diagnosis and on the clinical findings at the time of confirmation of diagnosis and the need for penetrating keratoplasty. In contact lens-associated keratitis, the first crucial step is to take AK into consideration and perform a PCR test as timely confirmation of diagnosis of AK is imperative to prevent long-term ocular morbidity.
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Padua MFFE, Masangkay FR, Alejandro GJD, Milanez GDJ. Detection of Acanthamoeba spp. in groundwater sources in a rural area in the Philippines. JOURNAL OF WATER AND HEALTH 2023; 21:138-146. [PMID: 36705503 DOI: 10.2166/wh.2023.258] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Research on free-living amoebae (FLA) and its public health implication as an etiologic agent of parasitic infection in humans has recently gained traction in the Philippines. This study aimed to identify potential FLAs in collected groundwater samples from Masinloc, Zambales, Philippines. Fifty-four (54) water samples were collected in 250-mL sterile polyethylene containers by purposive sampling from selected groundwater sources in six (6) barangays of Masinloc. The samples were vacuum filtered through a 1.2-μm pore glass microfiber filter, cultured onto non-nutrient agar (NNA) lawned with Escherichia coli, and observed microscopically for amoebic growth for 14 days using light microscopy. Amoebic growth was observed in 11.1% (6/54) of water samples. DNAs from positive samples were extracted and were made to react with polymerase chain reaction using Acanthamoeba-specific JDP1 (5'-GGCCCAGATCGTTTACCGTGAA-3') and JDP2 (5'-TCTCACAAGCTGCTAGGGAGTCA-3') primers, and universal primer Euk A (5'-AACCTGGTTGATCCTGCCAGT-3') and Euk B (5'-TGATCCTTCTGCAGGTTCACCTAC-3'). The presence of Acanthamoeba genotypes T4, T7, and T11 was confirmed using molecular and phylogenetic analysis. Our results confirmed that groundwater sources from two of six sampling sites (33.3%) in Masinloc, Zambales, were contaminated with potentially pathogenic FLAs. Proper identification of risk factors that may cause contamination consequently leads to the implementation of programs that will prevent future infections.
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Affiliation(s)
- Mark F F E Padua
- The Graduate School, University of Santo Tomas, Manila 1015, Philippines; Department of Medical Technology, Far Eastern University, Manila 1008, Philippines
| | - Frederick Ramirez Masangkay
- Department of Medical Technology, Faculty of Pharmacy, University of Santo Tomas, Manila 1015, Philippines E-mail:
| | | | - Giovanni De Jesus Milanez
- Department of Medical Technology, Faculty of Pharmacy, University of Santo Tomas, Manila 1015, Philippines E-mail:
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Müller-Morales CA, Vera-Duarte GR, Oliva-Bienzobas V, Ramirez-Miranda A, Navas A, Graue-Hernandez EO. Use of Amniotic Membrane Transplant and Deep Anterior Keratoplasty in a Patient with Bilateral Acanthamoeba Infectious Keratitis: A Case Report. Case Rep Ophthalmol 2023; 14:568-575. [PMID: 37901622 PMCID: PMC10601850 DOI: 10.1159/000533988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 09/03/2023] [Indexed: 10/31/2023] Open
Abstract
The aim of this study was to report a case with the use of amniotic membrane transplant and deep anterior keratoplasty in a patient with bilateral Acanthamoeba infectious keratitis as a treatment. A 20-year-old male presented with bilateral Acanthamoeba keratitis (AK) who was initially diagnosed with herpetic keratitis receiving full antiviral and corticosteroid topical treatment without any improvement. Corneal biopsy was performed to confirm the suspected diagnosis, and Acanthamoeba stromal cysts were identified in the sample. Treatment was initiated with 0.02% chlorhexidine, 0.1% propamidine isethionate, neomycin, and tropicamide/phenylephrine. Symptoms and clinical improvement were achieved between the 8th and 10th weeks, so corticosteroids were initiated. Treatment was continued until we observed a poor response in the left eye; therefore, an epithelial scraping and amniotic membrane placement were performed. Lately, the right eye underwent a deep anterior lamellar keratoplasty. A challenging case of bilateral AK managed with topical medications, amniotic membrane, and corneal keratoplasty. The earlier the disease is diagnosed, the better the outcome. If the diagnosis is delayed, the amoebas have penetrated deep into the corneal stroma, and successful therapy becomes difficult. A surgical option can be an early solution with a good prognosis for these cases.
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Affiliation(s)
- Carlos A Müller-Morales
- Instituto De Oftalmologia Fundacion Conde De Valenciana FAP, Department of Cornea, External Diseases and Refractive Surgery, Mexico City, Mexico
| | - Guillermo Raul Vera-Duarte
- Instituto De Oftalmologia Fundacion Conde De Valenciana FAP, Department of Cornea, External Diseases and Refractive Surgery, Mexico City, Mexico
| | - Valeria Oliva-Bienzobas
- Instituto De Oftalmologia Fundacion Conde De Valenciana FAP, Department of Cornea, External Diseases and Refractive Surgery, Mexico City, Mexico
| | - Arturo Ramirez-Miranda
- Instituto De Oftalmologia Fundacion Conde De Valenciana FAP, Department of Cornea, External Diseases and Refractive Surgery, Mexico City, Mexico
| | - Alejandro Navas
- Instituto De Oftalmologia Fundacion Conde De Valenciana FAP, Department of Cornea, External Diseases and Refractive Surgery, Mexico City, Mexico
| | - Enrique O Graue-Hernandez
- Instituto De Oftalmologia Fundacion Conde De Valenciana FAP, Department of Cornea, External Diseases and Refractive Surgery, Mexico City, Mexico
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Kaufman AR, Tu EY. Advances in the management of Acanthamoeba keratitis: A review of the literature and synthesized algorithmic approach. Ocul Surf 2022; 25:26-36. [DOI: 10.1016/j.jtos.2022.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 04/10/2022] [Accepted: 04/12/2022] [Indexed: 01/01/2023]
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Therapeutic Corneal Transplantation in Acanthamoeba Keratitis: Penetrating Versus Lamellar Keratoplasty. Cornea 2021; 41:396-401. [PMID: 34690262 DOI: 10.1097/ico.0000000000002880] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/05/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this article was to compare clinical outcomes between therapeutic penetrating keratoplasty (TPK), therapeutic deep anterior lamellar keratoplasty (TDALK), and optical penetrating keratoplasty (OPK) in Acanthamoeba keratitis. METHODS A literature search was conducted in online libraries from 1980 to 2021. The primary end points were best-corrected visual acuity (VA), graft survival, and infection recurrence. In addition, we enrolled 35 consecutive patients with AK from our practice evaluating best-corrected VA and high-order aberrations. RESULTS A total of 359 AK eyes from 33 published studies were retrieved from 175 publications screened. One hundred sixty-five eyes (73%) that underwent TPK and 39 eyes (84%) treated with TDALK had a clear graft at the last follow-up visit. Only the patients treated with OPK had 82 clear grafts (94%) during the follow-up period. Forty-seven (21%) of TPK patients reached VA ≥20/30, compared with 11 (25%) of TDALK patients and 35 (40%) of OPK patients. Acanthamoeba infection recurrence occurred in 38 eyes (16.8%) that underwent TPK, 9 (19%) that underwent TDALK, and 8 (9.5%) that underwent OPK. In our series, best-corrected visual acuity in nonsurgically treated patients was 1 ± 0.50 logMAR compared with 0 logMAR of surgically treated patients. High-order aberrations were significantly lower in surgically treated eyes after AK resolution, particularly in TDALK when compared with TPK patients. Best-corrected visual acuity was better in TDALK patients compared with TPK patients. CONCLUSIONS After AK resolution by 6 to 12 months of medical treatment, OPK seems to be the best surgical choice in patients with AK. If AK could not be eradicated by medical therapy, TDALK may be chosen in the early disease stage and TPK in later stages.
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Ahmed U, Anwar A, Ong SK, Anwar A, Khan NA. Applications of medicinal chemistry for drug discovery against Acanthamoeba infections. Med Res Rev 2021; 42:462-512. [PMID: 34472107 DOI: 10.1002/med.21851] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 07/13/2021] [Accepted: 08/17/2021] [Indexed: 01/16/2023]
Abstract
Acanthamoeba is a genus of free-living amoebae, pervasively found in the environment. Most of its pathogenic species are the causative agent of sight-threatening Acanthamoeba keratitis and fatal granulomatous amoebic encephalitis. Despite the advancements in the field of chemotherapy, treating Acanthamoeba infections is still challenging due to incomplete knowledge of the complicated pathophysiology. In case of infection, the treatment regimen for the patients is often ineffective due to delayed diagnosis, poor specificity, and side-effects. Besides the resistance of Acanthamoeba cysts to most of the drugs, the recurrence of infection further complicates the recovery. Thus, it is necessary to develop an effective treatment which can eradicate these rare, but serious infections. Based on various computational and in vitro studies, it has been established that the synthetic scaffolds such as heterocyclic compounds may act as potential drug leads for the development of antiamoebic drugs. In this review, we report different classes of synthetic compounds especially heterocyclic compounds which have shown promising results against Acanthamoeba. Moreover, the antiamoebic activities of synthetic compounds with their possible mode of actions against Acanthamoeba, have been summarized and discussed in this review.
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Affiliation(s)
- Usman Ahmed
- Department of Biological Sciences, School of Medical and Life Sciences, Sunway University, Subang Jaya, Selangor, Malaysia
| | - Ayaz Anwar
- Department of Biological Sciences, School of Medical and Life Sciences, Sunway University, Subang Jaya, Selangor, Malaysia
| | - Seng-Kai Ong
- Department of Biological Sciences, School of Medical and Life Sciences, Sunway University, Subang Jaya, Selangor, Malaysia
| | - Areeba Anwar
- Faculty of Defence Science and Technology, National Defence University of Malaysia, Kuala Lampur, Malaysia
| | - Naveed Ahmed Khan
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, UAE
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Wu J, Xie H. Orthokeratology lens-related Acanthamoeba keratitis: case report and analytical review. J Int Med Res 2021; 49:3000605211000985. [PMID: 33752507 PMCID: PMC7995463 DOI: 10.1177/03000605211000985] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 02/16/2021] [Indexed: 11/17/2022] Open
Abstract
Acanthamoeba keratitis (AK) is a rare but severe ocular infection with a significant risk of vision loss. Contact lens use is the main risk factor for AK. The orthokeratology (OK) lens, a specially designed contact lens, has been used worldwide as an effective method of myopia control. However, the OK lens is associated with an increased risk of Acanthamoeba infection. Many primary practitioners are concerned about this infection because of its relative rarity, the lack of promising therapeutic medications, and the need for referral. We herein report two cases of AK associated with OK lenses, present a systematic review of such cases, and discuss the possible reasons for the higher incidence rate of this infection in patients who wear OK lenses. We combined the clinical knowledge and skills of corneal specialists and lens experts with the sole objective of addressing these OK lens-related AK cases. We found that the most common risk factors were rinsing the lenses or lens cases with tap water. Prompt and accurate diagnosis along with adequate amoebicidal treatment are essential to ensure desirable outcomes for OK lens wearers who develop AK. Appropriate OK lens parameters and regular checkups are also important.
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Affiliation(s)
- Jinfang Wu
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, China
| | - Huatao Xie
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Bagga B, Sharma S, Gour RPS, Mohamed A, Joseph J, M Rathi V, Garg P. A randomized masked pilot clinical trial to compare the efficacy of topical 1% voriconazole ophthalmic solution as monotherapy with combination therapy of topical 0.02% polyhexamethylene biguanide and 0.02% chlorhexidine in the treatment of Acanthamoeba keratitis. Eye (Lond) 2020; 35:1326-1333. [PMID: 32719525 DOI: 10.1038/s41433-020-1109-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 07/13/2020] [Accepted: 07/16/2020] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To compare the efficacy of topical voriconazole 1% and the combination therapy of 0.02% polyhexamethylene biguanide (PHMB) and 0.02% chlorhexidine for the treatment of Acanthamoeba keratitis (AK). METHODS This is a prospective, pilot, double-masked randomized comparative study. Twenty-three eyes of 23 patients with microbiologically (smear and/or growth on culture) confirmed AK were randomized to group BG (PHMB 0.02% and chlorhexidine 0.02%) or group VZ (voriconazole 1%). Primary outcome measure was change in geometric mean (GM) of the corneal ulcer size at final visit. Secondary outcome measures were change in visual acuity. RESULTS Out of 71 patients with confirmed AK seen during study period, 23 patients were recruited and 18 patients completed minimum 2 weeks of treatment and further analyzed. Ten patients received BG, whereas eight received VZ. Median ulcer size measured as GM of infiltrate decreased from 5.7 mm (IQR, 5.3-6.5 mm) (p = 0.02) to 1 mm (IQR, 0-4.3 mm) in group BG and from 4.5 mm (IQR, 1.8-5.1 mm) (p < 0.05) to 0.7 mm (IQR, 0-1.6 mm) in VZ group. Median visual acuity improved from 1.79 (IQR, 1.48-2.78) to 1.10 (IQR, 0.48-1.79) in BG group (p = 0.02) and from 1.60 (IQR, 1.00-2.78) to 0.80 (IQR, 0.48-1.30) in VZ group (p = 0.18). CONCLUSION These outcomes suggest that topical VZ as a monotherapy in AK treatment is effective and comparable to BG combination therapy but needs trials with larger sample size and longer follow-up to provide conclusive evidence.
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Affiliation(s)
- Bhupesh Bagga
- The Cornea Institute, L V Prasad Eye Institute, Hyderabad, India.
| | - Savitri Sharma
- Jhaveri Microbiology Centre, L V Prasad Eye Institute, Hyderabad, India
| | | | - Ashik Mohamed
- Ophthalmic Biophysics, L V Prasad Eye Institute, Hyderabad, India
| | - Joveeta Joseph
- Jhaveri Microbiology Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Varsha M Rathi
- The Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
| | - Prashant Garg
- The Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
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