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Vilares-Morgado R, Ferreira AM, Marques-Couto P, Madeira C, Moreira R, Torrão L, Neves-Cardoso P, Cunha AM, Rebelo S, Pinheiro-Costa J. Clinical outcomes and prognostic factors in Acanthamoeba keratitis. Cont Lens Anterior Eye 2024; 47:102119. [PMID: 38220498 DOI: 10.1016/j.clae.2023.102119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 11/23/2023] [Accepted: 12/31/2023] [Indexed: 01/16/2024]
Abstract
PURPOSE To report clinical findings and prognostic factors for visual and morphological outcomes in patients with Acanthamoeba keratitis (AK). METHODS Single-center, retrospective, longitudinal study of 51 cases of AK diagnosed by real-time polymerase chain reaction (RT-PCR) between March 2010 and October 2022. The primary outcome was the final best corrected visual acuity (BCVA). Poor visual outcome was defined as a final BCVA ≥ 1 logMAR unit, while good visual outcome was defined as a final BCVA < 1 logMAR unit. Eyes from these two groups were compared, regarding demographic and initial clinical variables, anti-Acanthamoeba treatment used, and complications of the disease. Early diagnosis was defined as ≤ 14 days from symptom onset to diagnostic confirmation and initiation of Acanthamoeba medical treatment. Multivariable logistic regression was used to determine predictors of poor visual outcome. RESULTS A total of 51 eyes from 46 patients diagnosed with AK, all contact lens (CL) wearers, were included in this study. Average follow-up was 39.0 ± 30.2 [total range 14-120] months. Thirty-one eyes (60.8 %) presented good visual outcome, with a lower baseline age (30.5 ± 9.0 vs. 42.3 ± 15.8; p = 0.020), better initial BCVA (0.8 ± 0.7 logMAR units vs. 1.3 ± 0.9 logMAR units; p = 0.047), higher rate of early diagnosis (45.2 % vs. 5.6 %; p = 0.004), and higher rate of therapeutic epithelial debridement (64.5 % vs. 10 %; p < 0.001). 20 eyes (39.2 %) presented poor visual outcome, with 12 eyes undergoing evisceration/enucleation (23.5 %). These 20 eyes presented a higher rate of complications (90 % vs. 61.3 %; p = 0.031). In multivariable analysis, early diagnosis of AK (OR 19.78; 95 % CI 2.07-189.11; p = 0.010) and therapeutic epithelial debridement (OR 19.02; 95 % CI 3.27-110.57; p = 0.001) were associated with a good visual outcome. CONCLUSIONS In the present study, poor visual outcome was present in 39 % of affected eyes. Early AK diagnosis (≤14 days from symptom onset) and therapeutic epithelial debridement were associated with good final visual outcome.
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Affiliation(s)
- Rodrigo Vilares-Morgado
- Department of Ophthalmology, Centro Hospitalar Universitáro de São João, Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Ana Margarida Ferreira
- Department of Ophthalmology, Centro Hospitalar Universitáro de São João, Porto, Portugal
| | - Pedro Marques-Couto
- Department of Ophthalmology, Centro Hospitalar Universitáro de São João, Porto, Portugal
| | - Carolina Madeira
- Department of Ophthalmology, Centro Hospitalar Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Raúl Moreira
- Department of Ophthalmology, Centro Hospitalar Universitáro de São João, Porto, Portugal
| | - Luís Torrão
- Department of Ophthalmology, Centro Hospitalar Universitáro de São João, Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Pedro Neves-Cardoso
- Department of Ophthalmology, Centro Hospitalar Universitáro de São João, Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ana Maria Cunha
- Department of Ophthalmology, Centro Hospitalar Universitáro de São João, Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Sandra Rebelo
- Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal; Molecular Biology Laboratory, Department of Clinical Pathology, Centro Hospitalar Universitário de São João, Portugal
| | - João Pinheiro-Costa
- Department of Ophthalmology, Centro Hospitalar Universitáro de São João, Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal; Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
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Eguchi H, Hotta F, Kuwahara T, Nakayama-Imaohji H, Kusaka S, Shimomura Y. Acute keratoconjunctivitis due to contamination of contact lens care solution with histamine-producing Raoultella species: A case report. Medicine (Baltimore) 2017; 96:e9310. [PMID: 29390396 PMCID: PMC5815808 DOI: 10.1097/md.0000000000009310] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Contact lens storage cases are known to be contaminated by a significant number of bacteria. However, histamine-producing Raoultella species has not been reported to contaminate contact lens storage case. PATIENT CONCERNS A 27-year-old woman with keratoconjunctivitis that developed in the left eye owing to a cosmetic contact lens and poor hygiene was referred to our hospital. The corrected visual acuity was hand motion. DIAGNOSES Corneal infection other than Acanthamoeba keratitis (AK) and corneal hypoxia were excluded. INTERVENTIONS We initiated empirical therapy for AK, although no cysts or trophozoites were detected in the cornea and in the lens care solution. Analysis of 16S rDNA sequences from the lens care solution yielded the highest homology with Raoultella species, which are histamine-producing bacteria. Histamine was estimated to be 492 ng/mL in the lens care solution. OUTCOMES Her clinical course was distinct from that of usual AK cases. The corrected visual acuity increased up to (1.2) only 5 days after initiating empirical therapy. LESSONS To our knowledge, this is the first report to indicate an association between histamine-producing bacteria and keratoconjunctivitis. We should pay an attention to the microbial contamination of contact lens storage cases by histamine producing bacteria.
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Affiliation(s)
- Hiroshi Eguchi
- Department of Ophthalmology, Kindai University Sakai Hospital, Harayamadai, Minami-ku, Sakai, Osaka, Japan
| | - Fumika Hotta
- Department of Ophthalmology, Kindai University Sakai Hospital, Harayamadai, Minami-ku, Sakai, Osaka, Japan
| | - Tomomi Kuwahara
- Department of Molecular Microbiology, Faculty of Medicine, Kagawa University, Ikenobe, Miki, Kagawa, Japan
| | - Haruyuki Nakayama-Imaohji
- Department of Molecular Microbiology, Faculty of Medicine, Kagawa University, Ikenobe, Miki, Kagawa, Japan
| | - Shunji Kusaka
- Department of Ophthalmology, Kindai University Sakai Hospital, Harayamadai, Minami-ku, Sakai, Osaka, Japan
| | - Yoshikazu Shimomura
- Department of Ophthalmology, Kindai University, Faculty of Medicine, 377–2, Ohonohigashi, Osakasayama, Osaka, Japan
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Lamy R, Chan E, Good SD, Cevallos V, Porco TC, Stewart JM. Riboflavin and ultraviolet A as adjuvant treatment against Acanthamoeba cysts. Clin Exp Ophthalmol 2016; 44:181-7. [PMID: 26355273 DOI: 10.1111/ceo.12644] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 08/02/2015] [Accepted: 09/07/2015] [Indexed: 01/24/2023]
Abstract
BACKGROUND Experimental studies have shown that the standard dose of riboflavin (R) or R + ultraviolet-A (UVA) as solo treatment are not able to exterminate Acanthamoeba cysts or even trophozoites. The purpose of this study is to determine whether the application of R + UVA can enhance the cysticidal effects of cationic antiseptic agents in vitro. METHODS The log of either polyhexamethylene biguanide or chlorhexidine minimal cysticidal concentration in solutions containing riboflavin (concentrations 0.1, 0.05 and 0.025%) plus either Acanthamoeba castellanii cysts or Acanthamoeba polyphaga cysts was determined and compared in groups treated with UVA 30 mW/cm(2) for 30 min and in control groups (with no exposure to UVA). A permutation test was used to determine the P value associated with treatment. RESULTS Regardless of the riboflavin concentration and UVA treatment condition, no trophozoites were seen in plates where the cysts were previously exposed to cationic antiseptic agent concentrations ≥200 µg/mL for Acanthamoeba castellanii samples and ≥100 µg/mL for A. polyphaga samples. There was no statistical evidence that R + UVA treatment was associated with minimal cysticidal concentration (P = 0.82). CONCLUSION R + UVA in doses up to 10 times higher than recommended for corneal crosslinking does not enhance the cysticidal effect of either polyhexamethylene biguanide or chlorhexidine in vitro.
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Affiliation(s)
- Ricardo Lamy
- Department of Ophthalmology, University of California - San Francisco, San Francisco, California, USA
| | - Elliot Chan
- Department of Ophthalmology, University of California - San Francisco, San Francisco, California, USA
| | - Samuel D Good
- Department of Ophthalmology, University of California - San Francisco, San Francisco, California, USA
| | - Vicky Cevallos
- Francis I. Proctor Foundation, University of California - San Francisco, San Francisco, California, USA
| | - Travis C Porco
- Francis I. Proctor Foundation, University of California - San Francisco, San Francisco, California, USA
| | - Jay M Stewart
- Department of Ophthalmology, University of California - San Francisco, San Francisco, California, USA
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Makdoumi K, Bäckman A, Mortensen J, Magnuson A, Crafoord S. Comparison of UVA- and UVA/riboflavin-induced growth inhibition of Acanthamoeba castellanii. Graefes Arch Clin Exp Ophthalmol 2012; 251:509-14. [PMID: 23079692 DOI: 10.1007/s00417-012-2176-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 09/25/2012] [Accepted: 10/02/2012] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To investigate whether ultraviolet light (UVA) at 365 nm can inhibit/eliminate Acanthamoeba growth and if riboflavin would potentiate such an association. METHODS Acanthamoeba castellanii in a fluid medium with a concentration of approximately 1.7 × 10(4) protozoa/ml were prepared with (0.01 %) and without riboflavin. Exposure of UVA (dose 5.475 J/cm(2)) took place twice, with each illumination period followed by culturing of 10 μl in peptone yeast-extract glucose (PYG) medium for 7 days. Every suspension prepared had a non-exposed control solution. Determination of Acanthamoeba was conducted daily, by count in Burker chamber days 4 through 7 after exposure. Statistical analysis was done by repeated-measurement ANOVA and post-hoc analysis for unpaired samples. RESULTS The exposure of ultraviolet light resulted in an inhibited growth of Acanthamoeba compared to the non-exposed solutions, with a statistically significant reduction over time (p = 0.0003). The addition of riboflavin did not amplify the effect, and there were no tendencies for an interaction effect between UVA and riboflavin. CONCLUSIONS The antiprotozoal effect of the UVA wavelength, utilized in CXL, is solely mediated by ultraviolet light, and riboflavin does not seem to amplify the antimicrobial efficacy.
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Affiliation(s)
- Karim Makdoumi
- Department of Ophthalmology, Örebro University Hospital, 701 85, Örebro, Sweden.
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