title: Acanthamoeba sclerokeratitis: treatment with systemic immunosuppression.
abstract: OBJECTIVE
  This study describes the clinical features, management, and outcome of 19 patients who had severe Acanthamoeba sclerokeratitis (ASK) unresponsive to conventional management, requiring systemic immunosuppression to control disease.
  
  
  METHODS
  Retrospective, non-comparative, interventional case series.
  
  
  METHODS
  Records of all patients with Acanthamoeba keratitis treated at Moorfields Eye Hospital between 1989 and 2000 were reviewed. From more than 200 patients, 19 who developed ASK treated with systemic immunosuppression were identified.
  
  
  METHODS
  Visual acuity, level of pain, and degree of inflammation were recorded after immunosuppressive treatment.
  
  
  RESULTS
  ASK requiring immunosuppression occurred in 20 eyes of 19 patients (11 males and 8 females). The mean age (mean +/- standard deviation) at onset was 38.6 +/- 13.2 years. On presentation, best-corrected visual acuity was counting fingers or worse in 11 eyes (55%), 6/18 to 6/60 in 5 eyes (25%), and 6/12 or better in 4 eyes (20%). The mean time between onset of initial symptoms of Acanthamoeba keratitis and commencement of systemic immunosuppression was 4.8 +/- 3.5 months. The mean duration of immunosuppression required to control inflammation was 7.2 +/- 3.9 months. Severe scleritic pain remained uncontrolled in two patients and resulted in enucleation. Best-corrected visual acuity at final follow-up was counting fingers or worse in eight eyes (40%), 6/18 to 6/60 in six eyes (30%), and 20/40 or better in six eyes (30%). The mean follow-up period after resolution of inflammation was 24.3 +/- 20.9 months (range, 0.2-59.7 months).
  
  
  CONCLUSIONS
  ASK is an uncommon complication of Acanthamoeba keratitis. The scleritis associated with this infection seems to be an immune-mediated response. After topical amebicidal treatment, systemic immunosuppression may be required to control the pain and tissue destruction associated with ASK.
authors.affiliation: Moorfields Eye Hospital, London, England UK.
authors.forename: Graham A
authors.initials: GA
authors.lastname: Lee
authors.forename: Trevor B
authors.initials: TB
authors.lastname: Gray
authors.forename: John K G
authors.initials: JK
authors.lastname: Dart
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Pavesio
authors.forename: Linda A
authors.initials: LA
authors.lastname: Ficker
authors.forename: D Frank P
authors.initials: DF
authors.lastname: Larkin
authors.forename: Melville M
authors.initials: MM
authors.lastname: Matheson
mesh_terms: D015823:Acanthamoeba Keratitis / Q000188:drug therapy* / Q000473:pathology; D000293:Adolescent; D000328:Adult; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D003263:Contact Lenses, Hydrophilic / Q000009:adverse effects; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy; D012189:Retrospective Studies; D015423:Scleritis / Q000188:drug therapy* / Q000469:parasitology / Q000473:pathology; D014792:Visual Acuity
chemical_list: D000981:Antiprotozoal Agents; D007166:Immunosuppressive Agents