[Clinical management and prognosis in Acanthamoeba keratitis: a retrospective study of 25 cases].
OBJECTIVE
To assess risk factors, clinical characteristics, diagnosis and outcome in patients with Acanthamoeba keratitis.


METHODS
We reviewed 23 patients (25 eyes) treated for Acanthamoeba keratitis in the XV-XX Hospital between November 1994 and October 2000. Acanthamoeba were found either in corneal scrapings and/or contact lenses and/or storage solutions.


RESULTS
A predisposing factor was found in 22/23 patients: most of them (20/22) were contact lens (CL) wearers, two patients had a recent history of corneal trauma, and 15/23 patients had been treated for presumed herpetic keratitis before examination in our hospital. The average delay between first symptoms and diagnosis was 2 months. All patients were treated with two or three topical antiparasitic eye drops for 2 to 6 months. Five patients received systemic treatment (ketoconazole or itraconazole). Nine eyes received surgical treatment: penetrating keratoplasty in eight cases, conjunctival flap in one case, enucleation in one case. Visual outcome was poor in ten eyes (less than 20/60) because of delayed diagnosis.


CONCLUSIONS
Acanthamoeba keratitis is a serious vision-threatening disease. Early diagnosis and treatment are essential for improving visual outcome. Methods such as confocal microscopy and Acanthamoeba-PCR, allowing earlier diagnosis and treatment, will improve the management of Acanthamoeba keratitis.
Cardine
S
S
Service d'Ophtalmologie 5, Centre Hospitalier National d'Optalmologie des Quinze-Vingts, Paris.
Bourcier
T
T
Chaumeil
C
C
Zamfir
O
O
Borderie
V
V
Laroche
L
L
D015823:Acanthamoeba Keratitis / Q000175:diagnosis / Q000188:drug therapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies