Prognostic factors in Acanthamoeba keratitis

• Published in: Canadian journal of ophthalmology 2012-06, Vol.47 (3), p.312-317
• Main Authors: Kaiserman, Igor, MD, MSc, MHA, Bahar, Irit, MD, McAllum, Penny, MBChB, FRANZCO, Srinivasan, Sathish, MD, FRCSEd, FRCOpth, Elbaz, Uri, MD, Slomovic, Allan R., MD, FRCSC, Rootman, David S., MD, FRCSC
• Format: Article
• Language: English
• Subjects: Acanthamoeba Keratitis - diagnosis; Acanthamoeba Keratitis - drug therapy; Acanthamoeba Keratitis - physiopathology; Adolescent; Adult; Aged; Antiprotozoal Agents - therapeutic use; Contact Lenses, Hydrophilic - parasitology; Disposable Equipment; Female; Humans; Internal Medicine; Male; Middle Aged; Ophthalmology; Prognosis; Risk Factors; Visual Acuity - physiology; Young Adult
• ISSN: 0008-4182; 1715-3360
• DOI: 10.1016/j.jcjo.2012.03.040

Abstract Objective To assess the prognostic factors influencing visual prognosis and length of treatment after acanthamoeba keratitis (AK). Participants Forty-two AK eyes of 41 patients treated between 1999 and 2006 were included. Methods A diagnosis of AK was made on the basis of culture results with a corresponding clinical presentation. We calculated the prognostic effect of the various factors on final visual acuity and the length of treatment. Multivariate regression analysis was used to adjust for the simultaneous effects of the various prognostic factors. Results Mean follow-up was 19.7 ± 21.0 months. Sixty-four percent of cases had > 1 identified risk factor for AK, the most common risk factor being contact lens wear (92.9% of eyes). At presentation, median best spectacle corrected visual acuity (BCVA) was 20/200 (20/30 to Hand Motion [HM]) that improved after treatment to 20/50 (20/20 to Counting Fingers [CF]). Infection acquired by swimming or related to contact lenses had significantly better final BCVA ( p = 0.03 and p = 0.007, respectively). Neuritis and pseudodendrites were also associated with better final BCVA ( p = 0.04 and p = 0.05, respectively). Having had an epithelial defect on presentation and having been treated with topical steroid were associated with worse final best spectacle corrected visual acuity (BSCVA) ( p = 0.0006 and p = 0.04). Multivariate regression analysis found a good initial visual acuity ( p = 0.002), infections related to swimming ( p = 0.01), the absence of an epithelial defect ( p = 0.03), having been treated with chlorhexidine ( p = 0.05), and not having receive steroids ( p = 0.003) to significantly forecast a good final BCVA. Conclusions We identified several prognostic factors that can help clinicians evaluate the expected visual damage of the AK infection and thus tailor treatment accordingly.