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Blaser F, Bajka A, Grimm F, Metzler S, Herrmann D, Barthelmes D, Zweifel SA, Said S. Assessing PCR-Positive Acanthamoeba Keratitis-A Retrospective Chart Review. Microorganisms 2024; 12:1214. [PMID: 38930596 PMCID: PMC11205950 DOI: 10.3390/microorganisms12061214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 06/04/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
Ophthalmologists' diagnostic and treatment competence in Acanthamoeba keratitis varies widely. This investigator-initiated, retrospective, single-center chart review examined the electronic patient files regarding PCR-positive Acanthamoeba keratitis. We included corneal and contact lens assessments. We further reviewed the patient's medical history, corneal scraping results regarding viral or fungal co-infections, and the duration from symptom onset to final diagnosis. We identified 59 eyes of 52 patients from February 2010 to February 2023, with 31 of 52 (59.6%) being female patients. The median (IQR, range) patient age was 33 (25.3 to 45.5 [13 to 90]) years, and the mean (SD, range) time to diagnosis after symptom onset was 18 (10.5 to 35 [3 to 70]) days. Overall, 7 of 52 (7.7%) patients displayed a bilateral Acanthamoeba infection, and 48 (92.3%) used contact lenses at symptom onset. Regarding other microbiological co-infections, we found virologic PCR testing in 45 of 52 (86.5%) patients, with 3 (6.7%) positive corneal scrapings. Fungal cultures were performed in 49 of 52 (94.2%) patients, with 5 (10.2%) positive corneal scrapings. The medical treatment success rate was 45/46 (97.8%). This study raises awareness of patient education in contact lens handling and screens for further microbial co-infections in suspected Acanthamoeba cases.
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Affiliation(s)
- Frank Blaser
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland (S.S.)
| | - Anahita Bajka
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland (S.S.)
| | - Felix Grimm
- Institute of Parasitology, University of Zurich, 8057 Zurich, Switzerland
| | - Simone Metzler
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland (S.S.)
| | - Didier Herrmann
- Institute of Optometry, University of Applied Science, 4600 Olten, Switzerland
| | - Daniel Barthelmes
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland (S.S.)
| | - Sandrine Anne Zweifel
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland (S.S.)
| | - Sadiq Said
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland (S.S.)
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Posarelli M, Passaro ML, Avolio FC, Costagliola C, Semeraro F, Romano V. The incidence of severe complications in acanthamoeba keratitis: Qualitative and quantitative systematic assessment. Surv Ophthalmol 2024:S0039-6257(24)00069-9. [PMID: 38885760 DOI: 10.1016/j.survophthal.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 06/04/2024] [Accepted: 06/06/2024] [Indexed: 06/20/2024]
Abstract
Acanthamoeba keratitis (AK) is a rare, sight-threating corneal infection. The disease is challenging to diagnose and treat, and the amoeba can rapidly encyst, persisting in the tissue and causing recurrences. Medical therapy is conventionally considered the first line treatment, but advanced cases could require more invasive treatments like a "chaud" corneal transplant. We review the incidence of severe complications in patients affected by AK. Of 439 reports screened, 158 met our inclusion criteria. Incidence of severe complications was low, with 2.21 % patients developing perforation, 1 % requiring evisceration/enucleation and less than 1 % developing endophthalmitis. Corneal transplantation was required in 16.68 % of the cases. According to our results, and considering the reported incidences of these complications in other infectious keratitis, AK patients have an overall low risk of developing perforation, endophthalmitis, and enucleation/evisceration. Nevertheless, data available in the literature remain poor, and further randomized control trials are needed to confirm our findings.
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Affiliation(s)
- Matteo Posarelli
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK; Ophthalmology Unit of the Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Maria Laura Passaro
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy; Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
| | - Fabio Claudio Avolio
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy
| | - Ciro Costagliola
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy
| | - Francesco Semeraro
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Ophthalmology Clinic, University of Brescia, Brescia, Italy; Eye Unit, ASST Spedali Civili di Brescia, Piazzale Spedali Civili, 1, 25123 Brescia, Italy
| | - Vito Romano
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Ophthalmology Clinic, University of Brescia, Brescia, Italy; Eye Unit, ASST Spedali Civili di Brescia, Piazzale Spedali Civili, 1, 25123 Brescia, Italy; Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK.
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Kaiser KP, Wissiak E, Daas L, Walochnik J, Ardjomand N. Use of In Vivo Corneal Confocal Microscopy to Guide Excimer Laser With Adjunctive Mitomycin C for Treatment of Recalcitrant Acanthamoeba Keratitis. Cornea 2024; 43:652-657. [PMID: 38347671 DOI: 10.1097/ico.0000000000003494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 01/07/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE The aim of this study was to describe 3 cases of recalcitrant Acanthamoeba keratitis (AK) that were successfully treated using in vivo corneal confocal microscopy (IVCM) to guide excimer laser ablation depth with adjunctive mitomycin C 0.02%. METHODS Three patients diagnosed with AK did not respond to several weeks of intensive topical therapy with antiamoebic agents. The patient underwent phototherapeutic keratectomy with topical mitomycin C 0.02% application. The maximum stromal depth of cysts measured by IVCM was 80 μm, 100 μm, and 240 μm, and the stromal ablation depths were 80 μm, 100 μm, and 100 μm, respectively. RESULTS In all 3 eyes, AK resolved after a single excimer laser application, and topical treatment was gradually discontinued within 6 weeks afterward. In 1 eye, penetrating corneal transplantation was performed 6 weeks after phototherapeutic keratectomy because of ongoing severe corneal pain. IVCM and histology of the corneal transplant did not reveal any Acanthamoeba cysts within the excised corneal button. No recurrence was observed during the follow-up period of 19 to 34 months. CONCLUSIONS IVCM-guided phototherapeutic keratectomy with mitomycin C 0.02% seems to be a safe and successful approach for the treatment of AK, especially in cases of resistance to topical treatment. Corneal IVCM should be performed before laser application to measure cyst depth, determine ablation depth, and assess postoperative treatment success.
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Affiliation(s)
| | - Elfriede Wissiak
- Department of Ophthalmology, Medical University Graz, Graz, Austria
| | - Loay Daas
- Department of Ophthalmology, Saarland University, UKS, Homburg/Saar, Germany ; and
| | - Julia Walochnik
- Institute of Specific Prophylaxis and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Navid Ardjomand
- Department of Ophthalmology, Medical University Graz, Graz, Austria
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Durand ML, Barshak MB, Sobrin L. Eye Infections. N Engl J Med 2023; 389:2363-2375. [PMID: 38118024 DOI: 10.1056/nejmra2216081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Affiliation(s)
- Marlene L Durand
- From the Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital (M.L.D., M.B.B.), and the Infectious Disease Service (M.L.D., M.B.B.) and the Department of Ophthalmology (M.L.D., L.S.), Massachusetts Eye and Ear - both in Boston
| | - Miriam B Barshak
- From the Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital (M.L.D., M.B.B.), and the Infectious Disease Service (M.L.D., M.B.B.) and the Department of Ophthalmology (M.L.D., L.S.), Massachusetts Eye and Ear - both in Boston
| | - Lucia Sobrin
- From the Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital (M.L.D., M.B.B.), and the Infectious Disease Service (M.L.D., M.B.B.) and the Department of Ophthalmology (M.L.D., L.S.), Massachusetts Eye and Ear - both in Boston
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Shareef O, Shareef S, Saeed HN. New Frontiers in Acanthamoeba Keratitis Diagnosis and Management. BIOLOGY 2023; 12:1489. [PMID: 38132315 PMCID: PMC10740828 DOI: 10.3390/biology12121489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/01/2023] [Accepted: 12/01/2023] [Indexed: 12/23/2023]
Abstract
Acanthamoeba Keratitis (AK) is a severe corneal infection caused by the Acanthamoeba species of protozoa, potentially leading to permanent vision loss. AK requires prompt diagnosis and treatment to mitigate vision impairment. Diagnosing AK is challenging due to overlapping symptoms with other corneal infections, and treatment is made complicated by the organism's dual forms and increasing virulence, and delayed diagnosis. In this review, new approaches in AK diagnostics and treatment within the last 5 years are discussed. The English-language literature on PubMed was reviewed using the search terms "Acanthamoeba keratitis" and "diagnosis" or "treatment" and focused on studies published between 2018 and 2023. Two hundred sixty-five publications were initially identified, of which eighty-seven met inclusion and exclusion criteria. This review highlights the findings of these studies. Notably, advances in PCR-based diagnostics may be clinically implemented in the near future, while antibody-based and machine-learning approaches hold promise for the future. Single-drug topical therapy (0.08% PHMB) may improve drug access and efficacy, while oral medication (i.e., miltefosine) may offer a treatment option for patients with recalcitrant disease.
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Affiliation(s)
- Omar Shareef
- School of Engineering and Applied Sciences, Harvard College, Cambridge, MA 02138, USA;
| | - Sana Shareef
- Department of Bioethics, Columbia University, New York, NY 10027, USA
| | - Hajirah N. Saeed
- Department of Ophthalmology, University of Illinois Chicago, Chicago, IL 60607, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA 02115, USA
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Chiang JCB, Roy M, Kim J, Markoulli M, Krishnan AV. In-vivo corneal confocal microscopy: Imaging analysis, biological insights and future directions. Commun Biol 2023; 6:652. [PMID: 37336941 DOI: 10.1038/s42003-023-05005-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/31/2023] [Indexed: 06/21/2023] Open
Abstract
In-vivo corneal confocal microscopy is a powerful imaging technique which provides clinicians and researcher with the capabilities to observe microstructures at the ocular surfaces in significant detail. In this Mini Review, the optics and image analysis methods with the use of corneal confocal microscopy are discussed. While novel insights of neuroanatomy and biology of the eyes, particularly the ocular surface, have been provided by corneal confocal microscopy, some debatable elements observed using this technique remain and these are explored in this Mini Review. Potential improvements in imaging methodology and instrumentation are also suggested.
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Affiliation(s)
- Jeremy Chung Bo Chiang
- School of Optometry and Vision Science, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- School of Optometry, College of Health and Life Sciences, Aston University, Birmingham, NSW, UK
| | - Maitreyee Roy
- School of Optometry and Vision Science, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Juno Kim
- School of Optometry and Vision Science, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Maria Markoulli
- School of Optometry and Vision Science, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Arun V Krishnan
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia.
- Department of Neurology, Prince of Wales Hospital, Sydney, NSW, Australia.
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