Ema Avdagic1, Hall F Chew2, Peter Veldman1, Elmer Y Tu3, Mansab Jafri4, Rutvi Doshi1, Andrea K Boggild5,6,7, James J Reidy1, Asim V Farooq1. 1. Department of Ophthalmology and Visual Science, University of Chicago, Chicago, Illinois, USA. 2. Department of Ophthalmology and Vision Science, University of Toronto, Toronto, Canada. 3. Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, USA. 4. Kansas City University of Medicine and Biosciences, Kansas City, Missouri, USA. 5. Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada. 6. Tropical Disease Unit, Toronto General Hospital, Toronto, Canada. 7. Public Health Ontario Laboratory, Public Health Ontario, Toronto, Canada.
Abstract
Purpose: To report a series of cases demonstrating the resolution of Acanthamoeba keratitis (AK) with adjunctive use of oral miltefosine. Methods: Retrospective case series. Results: The first case was a 27-year-old female who presented with severe pain and photophobia. The diagnosis of AK was made with confocal microscopy, which revealed a significant burden of stromal cysts. After approximately 2 weeks of adjunctive oral miltefosine therapy, there was a severe inflammatory response within the cornea followed by quick resolution of the AK. The second case was a 31-year-old male in whom the diagnosis of AK was confirmed by culture and polymerase chain reaction. Adjunctive oral miltefosine was started 3 months after presentation, leading to a quick resolution.Conclusions: Oral miltefosine may have cysticidal properties and should be considered as adjunctive therapy for the treatment of AK, particularly in cases with a significant burden of cysts or in cases recalcitrant to other treatments.
Purpose: To report a series of cases demonstrating the resolution of Acanthamoeba keratitis (AK) with adjunctive use of oral miltefosine. Methods: Retrospective case series. Results: The first case was a 27-year-old female who presented with severe pain and photophobia. The diagnosis of AK was made with confocal microscopy, which revealed a significant burden of stromal cysts. After approximately 2 weeks of adjunctive oral miltefosine therapy, there was a severe inflammatory response within the cornea followed by quick resolution of the AK. The second case was a 31-year-old male in whom the diagnosis of AK was confirmed by culture and polymerase chain reaction. Adjunctive oral miltefosine was started 3 months after presentation, leading to a quick resolution.Conclusions: Oral miltefosine may have cysticidal properties and should be considered as adjunctive therapy for the treatment of AK, particularly in cases with a significant burden of cysts or in cases recalcitrant to other treatments.