The rising incidence of Acanthamoeba keratitis: A 7-year nationwide survey and clinical assessment of risk factors and functional outcomes

• Published in: PloS one 2019-09, Vol.14 (9), p.e0222092-e0222092
• Main Authors: Randag, Anna C, van Rooij, Jeroen, van Goor, Arnoud T, Verkerk, Samuël, Wisse, Robert P L, Saelens, Isabelle E Y, Stoutenbeek, Remco, van Dooren, Bart T H, Cheng, Yanny Y Y, Eggink, Cathrien A
• Format: Article
• Language: English
• Subjects: Acanthamoeba; Acanthamoeba keratitis; Acanthamoeba Keratitis - epidemiology; Acanthamoeba Keratitis - physiopathology; Acanthamoeba Keratitis - therapy; Acuity; Adolescent; Adult; Aged; Biology and Life Sciences; Care and treatment; Child; Contact lenses; Cornea; Corneal transplantation; Corticosteroid drugs; Corticosteroids; Cysts; Decimals; Diagnosis; Diagnostic systems; Epidemiology; Eye (anatomy); Failure analysis; Female; Glucocorticoids; Health Surveys; Hospitals; Humans; Incidence; Keratitis; Male; Medical diagnosis; Medical research; Medicine and Health Sciences; Middle Aged; Pain; Patients; Performance prediction; Physical Sciences; Regression analysis; Research and Analysis Methods; Risk analysis; Risk Factors; Studies; Treatment Failure; Visual acuity; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0222092

To evaluate the incidence of Acanthamoeba keratitis in the Netherlands between 2009 and 2015 and to analyse predicting factors for treatment outcome. Patient characteristics, diagnostic methods, diagnostic delay, therapy prior to and after diagnosis, and visual outcome were obtained from medical files of all patients diagnosed with Acanthamoeba keratitis in the Netherlands between 2009 and 2015. A logistic regression analysis on treatment failure, defined as a best corrected visual acuity of less than 20/40 Snellen decimals (i.e. >0.3 logMAR or an approximate loss of three lines of visual acuity) and/or the need for keratoplasty, was performed to determine predicting factors. Two hundred and twenty-four eyes of 224 patients were included. Ninety-five percent of the patients were contact lens wearers, of whom 74% wore soft contact lenses. The number of cases increased from 16 in 2009 to 49 in 2015. This resulted in an estimated incidence of 1 in 21,000 for soft contact lens wearers in 2015. Eighty-seven eyes (39%) met the criteria for treatment failure. In a multivariable regression analysis, higher age at presentation, a higher severity stage and corticosteroid use before diagnosis were positively correlated with treatment failure. Early referral to a cornea specialist was associated with better clinical outcomes. Although Acanthamoeba keratitis is still a relatively uncommon disease, the incidence in soft contact lens wearers has increased to reach 1 in 21,000 in 2015. Treatment failure occurred in 39% of cases, with age, higher severity stage, corticosteroid use before diagnosis and indirect referral to a cornea specialist as important risks factors.