Weiyun Shi1, Mingna Liu, Hua Gao, Suxia Li, Lixin Xie. 1. State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, 5 Yanerdao Road, Qingdao, China.
Abstract
BACKGROUND: The purpose of this research is to evaluate the prognostic factors for graft survival after penetrating keratoplasty (PK) for medically unresponsive Acanthamoeba keratitis. METHODS: In this retrospective, interventional case series, 22 affected eyes underwent therapeutic penetrating keratoplasty for medically unresponsive Acanthamoeba keratitis at Shandong Eye Institute during a 10-year period (1996-2006). Diagnosis of Acanthamoeba keratitis was made prior to surgery for 15 eyes, while a delayed diagnosis was made for the other seven eyes. Appropriate anti-microbial agents were administered based on the suspected etiological agents. Intravenous hydrocortisone was given only once in two patients. Systemic and topical use of steroids was avoided within 2 to 3 weeks after operation. The six patients who were misdiagnosed had intravenous hydrocortisone for 3 days postoperatively, and routine administration of systemic and topical steroids until Acanthamoeba was detected. Patients were followed up for 6 to 24 months (mean, 10 months) after PK. RESULTS: Of these patients, none wore contact lenses. The possible causes for infection included trauma with plant matter or dust (13 cases), poultry-feeding (six cases), and occupational exposure to oil (one case). Eighteen grafts were clear at the end of the follow-up. Six eyes (28%) had amoebic recurrence at 2 to 3 weeks after PK, of which five were misdiagnosed prior to surgery and received postoperative corticosteroids treatment. Four of the six eyes that developed a recurrence were regrafted, while the other two remained clear for the ensuing follow-up period. CONCLUSIONS: PK may be performed in eyes with active Acanthamoeba keratitis. To improve the prognosis, surgeons should pay attention to antiamoebic therapy and avoid prescribing corticosteroids in the early postoperative period.
BACKGROUND: The purpose of this research is to evaluate the prognostic factors for graft survival after penetrating keratoplasty (PK) for medically unresponsive Acanthamoeba keratitis. METHODS: In this retrospective, interventional case series, 22 affected eyes underwent therapeutic penetrating keratoplasty for medically unresponsive Acanthamoeba keratitis at Shandong Eye Institute during a 10-year period (1996-2006). Diagnosis of Acanthamoeba keratitis was made prior to surgery for 15 eyes, while a delayed diagnosis was made for the other seven eyes. Appropriate anti-microbial agents were administered based on the suspected etiological agents. Intravenous hydrocortisone was given only once in two patients. Systemic and topical use of steroids was avoided within 2 to 3 weeks after operation. The six patients who were misdiagnosed had intravenous hydrocortisone for 3 days postoperatively, and routine administration of systemic and topical steroids until Acanthamoeba was detected. Patients were followed up for 6 to 24 months (mean, 10 months) after PK. RESULTS: Of these patients, none wore contact lenses. The possible causes for infection included trauma with plant matter or dust (13 cases), poultry-feeding (six cases), and occupational exposure to oil (one case). Eighteen grafts were clear at the end of the follow-up. Six eyes (28%) had amoebic recurrence at 2 to 3 weeks after PK, of which five were misdiagnosed prior to surgery and received postoperative corticosteroids treatment. Four of the six eyes that developed a recurrence were regrafted, while the other two remained clear for the ensuing follow-up period. CONCLUSIONS: PK may be performed in eyes with active Acanthamoeba keratitis. To improve the prognosis, surgeons should pay attention to antiamoebic therapy and avoid prescribing corticosteroids in the early postoperative period.
Authors: Andrea Naranjo; Alejandro Arboleda; Jaime D Martinez; Heather Durkee; Mariela C Aguilar; Nidhi Relhan; Neda Nikpoor; Anat Galor; Sander R Dubovy; Roger Leblanc; Harry W Flynn; Darlene Miller; Jean-Marie Parel; Guillermo Amescua Journal: Am J Ophthalmol Date: 2019-09-05 Impact factor: 5.258