Advances in the management of keratomycosis and Acanthamoeba keratitis.
OBJECTIVE
In the late 1960s, the management of fungal keratitis was a serious unresolved problem. Little was known of the epidemiology of the disease, and there were no antifungal agents formulated for use in the eye.


METHODS
A thorough review of the literature was done back to 1969 on clinical reports and experimental studies for keratomycosis and Acanthamoeba keratitis.


RESULTS
Since 1969, through basic and clinical research, the epidemiology of the disease worldwide is better understood. One new topical antifungal agent, natamycin, with efficacy against filamentous fungi has been developed and the pharmacokinetics of topically applied antifungal drops have been explored. Progress has been slow but the prognosis for keratomycosis has immeasurably improved over the period. Acanthamoeba was first recognized as an ocular pathogen in 1973 and was the cause of an epidemic in the 1980s caused by contaminated contact lens, although other risk factors were also identified. At the onset of the epidemic, there was no known treatment. but as a result of intense research efforts, within a few years a well-defined therapeutic approach had been developed that had a significant impact on the prognosis for this initially devastating infection. For both infections, the role of corticosteroids for controlling the inflammation remains controversial, but the place for keratoplasty is now well defined.


CONCLUSIONS
Although there has been steady progress in the management of both infections, continued research is the way to define more effective medical and surgical therapy.
O'Day
D M
DM
Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical School, Nashville, Tennessee 37232-8808, USA. denis.m.o'day@mcmail.vanderbilt.edu
Head
W S
WS
D015823:Acanthamoeba Keratitis / Q000628:therapy*; D000818:Animals; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000981:Antiprotozoal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D015821:Eye Infections, Fungal / Q000628:therapy*; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007267:Injections; D007634:Keratitis / Q000382:microbiology / Q000628:therapy; D015948:Keratoplasty, Penetrating; D009883:Ophthalmic Solutions / Q000008:administration & dosage / Q000627:therapeutic use; D011379:Prognosis
D000935:Antifungal Agents; D000981:Antiprotozoal Agents; D005938:Glucocorticoids; D009883:Ophthalmic Solutions