Acanthamoeba keratitis - is there another perspective - Extrapolations from the Acanthamoeba – fungal keratitis study

2020 ◽  
Keyword(s):  
Acanthamoeba Keratitis ◽  
Fungal Keratitis

Specificity of in Vivo Confocal Cornea Microscopy in Acanthamoeba Keratitis

2016 ◽  
Vol 27 (1) ◽  
pp. 10-15 ◽  
Author(s):  
Ágnes Füst ◽  
Jeannette Tóth ◽  
Gyula Simon ◽  
László Imre ◽  
Zoltán Z. Nagy
Keyword(s):  
Confocal Microscopy ◽  
Clinical Presentation ◽  
Acanthamoeba Keratitis ◽  
Fungal Keratitis ◽  
Response To Therapy ◽  
High Rate ◽  
Bacterial Keratitis ◽  
In Vivo Confocal Microscopy ◽  
Bright Spots

Purpose To report on the presence of 4 different structures visualized by confocal microscopy in patients whose clinical presentation suggested infection by Acanthamoeba. Methods Data and charts of 28 consecutive patients were analyzed in a retrospective study. Four types of structures were recognized by confocal microscopy performed with HRT II Rostock Cornea Module: trophozoites, double-walled cysts, signet rings, and bright spots. The 28 patients (mean age 30.8 years, range 17-61 years, 10 male, 18 female) were divided into 4 groups according to the diagnosis established later by microscopic examination of smear, culture, response to therapy, and the course of keratitis. The 4 groups were Acanthamoeba keratitis (AK), Acanthamoeba suspect (AK-suspect), bacterial keratitis (BK), and fungal keratitis (FK). Results The rate of patients in AK, AK-suspect, FK, and BK groups where bright spots were found were 100%, 100%, 40%, and 55%, respectively. The sensitivity of presence of bright spots in the in vivo confocal microscopy in Acanthamoeba keratitis was 100% (95% confidence interval [CI] 73.5% to 100.00%) and specificity was 50% (CI 24.7% to 75.4%). When cases where the only signs of Acanthamoeba were bright spots were excluded, and only those cases were counted where any of cysts, trophozoites, or signet rings were also found, the sensitivity was 67% (95% CI 34. 9% to 90.1%) and the specificity was 94% (95% CI 69.8% to 99.8%). Conclusions The relatively high rate of bright spots in non- Acanthamoeba keratitis challenges the assumption that bright spots seen by confocal microscopy are a specific indication of Acanthamoeba keratitis.

scholarly journals Amniotic membrane transplantation for infectious keratitis: a systematic review and meta-analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Darren Shu Jeng Ting ◽  
Christin Henein ◽  
Dalia G. Said ◽  
Harminder S. Dua
Keyword(s):  
Systematic Review ◽  
Case Series ◽  
Acanthamoeba Keratitis ◽  
Antimicrobial Treatment ◽  
Fungal Keratitis ◽  
Amniotic Membrane Transplantation ◽  
Infectious Keratitis ◽  
Randomized Controlled ◽  
Corneal Vascularization

AbstractInfectious keratitis (IK) is the 5th leading cause of blindness globally. Broad-spectrum topical antimicrobial treatment is the current mainstay of treatment for IK, though adjuvant treatment or surgeries are often required in refractory cases of IK. This systematic review aimed to examine the effectiveness and safety of adjuvant amniotic membrane transplantation (AMT) for treating IK. Electronic databases, including MEDLINE, EMBASE and Cochrane Central, were searched for relevant articles. All clinical studies, including randomized controlled trials (RCTs), non-randomized controlled studies and case series (n > 5), were included. Primary outcome measure was time to complete corneal healing and secondary outcome measures included corrected-distance-visual-acuity (CDVA), uncorrected-distance-visual-acuity (UDVA), corneal vascularization and adverse events. A total of twenty-eight studies (including four RCTs) with 861 eyes were included. When compared to standard antimicrobial treatment alone, adjuvant AMT resulted in shorter mean time to complete corneal healing (− 4.08 days; 95% CI − 6.27 to − 1.88; p < 0.001) and better UDVA (− 0.26 logMAR; − 0.50 to − 0.02; p = 0.04) at 1 month follow-up in moderate-to-severe bacterial and fungal keratitis, with no significant difference in the risk of adverse events (risk ratio 0.80; 0.46–1.38; p = 0.42). One RCT demonstrated that adjuvant AMT resulted in better CDVA and less corneal vascularization at 6 months follow-up (both p < 0.001). None of the RCTs examined the use of adjuvant AMT in herpetic or Acanthamoeba keratitis, though the benefit was supported by a number of case series. In conclusion, AMT serves as a useful adjuvant therapy in improving corneal healing and visual outcome in bacterial and fungal keratitis (low-quality evidence). Further adequately powered, high-quality RCTs are required to ascertain its therapeutic potential, particularly for herpetic and Acanthamoeba keratitis. Future standardization of the core outcome set in IK-related trials would be invaluable.

Acanthamoeba keratitis associated with fungal keratitis

2001 ◽  
Vol 131 (4) ◽  
pp. 508-509 ◽  
Author(s):  
Nicholas A. Froumis ◽  
Bartly J. Mondino ◽  
Ben J. Glasgow
Keyword(s):  
Acanthamoeba Keratitis ◽  
Fungal Keratitis

Acanthamoeba Keratitis: Current Status and Urgent Research Priorities

2019 ◽  
Vol 26 (30) ◽  
pp. 5711-5726 ◽  
Author(s):  
Naveed Ahmed Khan ◽  
Ayaz Anwar ◽  
Ruqaiyyah Siddiqui
Keyword(s):  
Rational Design ◽  
Research Priorities ◽  
Acanthamoeba Keratitis ◽  
Current Treatment ◽  
Research Literature ◽  
Current Status ◽  
Bibliographic Databases ◽  
Sequence Information ◽  
Therapeutic Measures ◽  
Genome Sequence Information

Background:First discovered in the early 1970s, Acanthamoeba keratitis has remained a major eye infection and presents a significant threat to the public health, especially in developing countries. The aim is to present a timely review of our current understanding of the advances made in this field in a comprehensible manner and includes novel concepts and provides clear directions for immediate research priorities.Methods:We undertook a search of bibliographic databases for peer-reviewed research literature and also summarized our published results in this field.Results:The present review focuses on novel diagnostic and therapeutic strategies in details which can provide access to management and treatment of Acanthamoeba keratitis. This coupled with the recently available genome sequence information together with high throughput genomics technology and innovative approaches should stimulate interest in the rational design of preventative and therapeutic measures. Current treatment of Acanthamoeba keratitis is problematic and often leads to infection recurrence. Better understanding of diagnosis, pathogenesis, pathophysiology and therapeutic regimens, would lead to novel strategies in treatment and prophylaxis.

Endothelial Cell Density and Central Corneal Thickness following Penetrating Keratoplasty of Acanthamoeba Keratitis Patients – A Retrospective Cross-Sectional Observational Study

2021 ◽  
Author(s):  
Lei Shi ◽  
Fabian Norbert Fries ◽  
Kassandra Xanthopoulou ◽  
Tanja Stachon ◽  
Loay Daas ◽  
...  
Keyword(s):  
Endothelial Cell ◽  
Observational Study ◽  
Cell Density ◽  
Central Corneal Thickness ◽  
Penetrating Keratoplasty ◽  
Corneal Thickness ◽  
Acanthamoeba Keratitis ◽  
Endothelial Cell Density ◽  
Cross Sectional ◽  
Time Point

Abstract Purpose To analyze endothelial cell density (ECD) and central corneal thickness (CCT) following penetrating keratoplasty (PKP) in Acanthamoeba keratitis (AK) patients. Patients and Methods In this retrospective, clinical, single-center, cross-sectional, observational study, patients were enrolled who underwent PKP at the Department of Ophthalmology of Saarland University Medical Center, Homburg/Saar, Germany between May 2008 and December 2016 with the diagnosis of AK. In all, 33 eyes of 33 patients (14 males, 42%) were enrolled; their mean age at the time of surgery was 39.5 ± 14.3 years. Postoperatively, AK patients received topical polyhexamethylene biguanide, propamidine isethionate, neomycin sulphate/gramicidin/polymixin B sulfate, and prednisolone acetate eye drops (5 ×/day each), and the topical treatment was tapered sequentially with 1 drop every 6 weeks over 6 months. CCT was recorded using Pentacam HR Scheimpflug tomography and ECD with the EM-3000 specular microscope before surgery and 3 and 6 months after surgery as well as after the first and second (complete) suture removal. Results ECD tended to decrease significantly from the time point before surgery (2232 ± 296 cells/mm2) to the time point 3 months after surgery (1914 ± 164 cells/mm2; p = 0.080) and to the time point after the first suture removal (1886 ± 557 cells/mm2; p = 0.066) and decrease significantly to the time point after the second suture removal (1650 ± 446 cells/mm2; p = 0.028). CCT did not change significantly over the analyzed time period (p ≥ 0.475). Conclusion In AK, endothelial cell loss does not seem to be accelerated following PKP, despite the postoperative use of diamidine and biguanide. A subsequent prospective comparative study should confirm our retrospective longitudinal analysis.

Fungal Keratitis and Contact Lenses: An Old Enemy Unrecognized or a New Nemesis on the Block?

2007 ◽  
Vol 33 (Supplement) ◽  
pp. 415-417 ◽  
Author(s):  
Sonal S. Tuli ◽  
Sandhya A. Iyer ◽  
William T. Driebe
Keyword(s):  
Contact Lenses ◽  
Fungal Keratitis
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