James McKelvie1,2, Moaz Alshiakhi2, Mohammed Ziaei1,2, Dipika V Patel1,2, Charles Nj McGhee1,2. 1. The Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. 2. The Department of Ophthalmology, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand.
Abstract
IMPORTANCE: Acanthamoeba is an increasingly prevalent cause of vision-threatening microbial keratitis. BACKGROUND: To assess the incidence, clinical presentation, diagnosis and outcomes of patients with Acanthamoeba keratitis (AK) in Auckland, New Zealand over a 7-year period. DESIGN: Retrospective observational consecutive case series. PARTICIPANTS: Fifty-eight eyes of 52 patients diagnosed with AK. METHODS: All cases of AK were identified using a cross-referenced search of clinical, laboratory and pharmacy records from March 2009 to May 2016. MAIN OUTCOME MEASURES: Demographic and clinical data were collected including age, gender, risk factors, clinical manifestations, initial diagnosis, diagnostic investigations, treatment, presenting and final visual acuity and surgical interventions. RESULTS: Contact lens (CL) use was noted in 96% of unilateral and 100% of bilateral cases. The mean duration of symptoms at presentation was 21 days and the mean duration from presentation to definitive diagnosis was 14 days. Initial diagnosis was recorded as CL-related keratitis in 70.6%, viral keratitis in 15.5% and AK in 12.0%. The diagnosis was confirmed with In vivo confocal microscopy (IVCM) in 67.2%, corneal scrape in 22.4%, corneal biopsy in 1.7% and clinically in 8.6%. IVCM sensitivity was 83.0%. Surgical intervention was required in four patients, all with delayed diagnosis (range 63-125 days). The incidence of AK has more than doubled when compared with the preceding 7-year period. CONCLUSIONS AND RELEVANCE: AK is a rare vision-threatening protozoal infection with rapidly-increasing incidence in New Zealand, predominantly affecting CL users. Diagnosis is often challenging and when delayed is associated with worse outcomes. IVCM offers rapid diagnosis with high sensitivity.
IMPORTANCE: Acanthamoeba is an increasingly prevalent cause of vision-threatening microbial keratitis. BACKGROUND: To assess the incidence, clinical presentation, diagnosis and outcomes of patients with Acanthamoeba keratitis (AK) in Auckland, New Zealand over a 7-year period. DESIGN: Retrospective observational consecutive case series. PARTICIPANTS: Fifty-eight eyes of 52 patients diagnosed with AK. METHODS: All cases of AK were identified using a cross-referenced search of clinical, laboratory and pharmacy records from March 2009 to May 2016. MAIN OUTCOME MEASURES: Demographic and clinical data were collected including age, gender, risk factors, clinical manifestations, initial diagnosis, diagnostic investigations, treatment, presenting and final visual acuity and surgical interventions. RESULTS: Contact lens (CL) use was noted in 96% of unilateral and 100% of bilateral cases. The mean duration of symptoms at presentation was 21 days and the mean duration from presentation to definitive diagnosis was 14 days. Initial diagnosis was recorded as CL-related keratitis in 70.6%, viral keratitis in 15.5% and AK in 12.0%. The diagnosis was confirmed with In vivo confocal microscopy (IVCM) in 67.2%, corneal scrape in 22.4%, corneal biopsy in 1.7% and clinically in 8.6%. IVCM sensitivity was 83.0%. Surgical intervention was required in four patients, all with delayed diagnosis (range 63-125 days). The incidence of AK has more than doubled when compared with the preceding 7-year period. CONCLUSIONS AND RELEVANCE: AK is a rare vision-threatening protozoal infection with rapidly-increasing incidence in New Zealand, predominantly affecting CL users. Diagnosis is often challenging and when delayed is associated with worse outcomes. IVCM offers rapid diagnosis with high sensitivity.
Authors: Marcin Padzik; Edyta B Hendiger; Lidia Chomicz; Marta Grodzik; Maciej Szmidt; Jarosław Grobelny; Jacob Lorenzo-Morales Journal: Parasitol Res Date: 2018-08-15 Impact factor: 2.289
Authors: Anna C Randag; Jeroen van Rooij; Arnoud T van Goor; Samuël Verkerk; Robert P L Wisse; Isabelle E Y Saelens; Remco Stoutenbeek; Bart T H van Dooren; Yanny Y Y Cheng; Cathrien A Eggink Journal: PLoS One Date: 2019-09-06 Impact factor: 3.240