title: Corneal graft survival after therapeutic keratoplasty for Acanthamoeba keratitis.
abstract: OBJECTIVE
  To describe corneal graft survival and visual outcome after therapeutic penetrating keratoplasty in patients with Acanthamoeba keratitis (AK) that is unresponsive to clinical treatment.
  
  
  METHODS
  Retrospective study. Thirty-two patients with AK who underwent therapeutic penetrating keratoplasty (tPK) from August 1996 to August 2005 were included. Data relating to clinical features, visual acuity, surgical technique, graft survival and complications were collected. Graft survival was evaluated by the Kaplan-Meier method and comparisons were performed using the Log-rank test.
  
  
  RESULTS
  Most patients (62.5%) were female. Mean age [+/- standard deviation (SD)] was 35 (+/- 13) years (range 15-68 years). All patients were contact lens wearers. Eighteen patients (56%) presented paralytic mydriasis and glaucoma during the treatment. Thirteen patients (40%) developed glaucoma after surgery; eight of them (61%) required a second PK because of graft failure. Of the 32 keratoplasty eyes, 56.2% presented graft failure at any follow-up point. Forty-five per cent of graft failures occurred before the 12 month follow-up, so 55% remained clear in the first year after surgery. Twelve patients underwent a second PK; seven of them failed and 45% were clear at 1 year. Two patients presented graft recurrence of amoebic infection. There was no significant difference in graft survival when eyes with or without mydriasis were compared (P = 0.40). Eyes with glaucoma presented a significantly shorter graft survival (P = 0.01).
  
  
  CONCLUSIONS
  Penetrating keratoplasty is a treatment option for eyes that are unresponsive to clinical treatment infections. However, graft survival is poor; postoperative glaucoma is frequent and is associated with shorter graft survival.
authors.affiliation: Federal University of São Paulo, Brazil. Renatatiemik@yahoo.com.br
authors.forename: Renata T
authors.initials: RT
authors.lastname: Kashiwabuchi
authors.forename: Denise
authors.initials: D
authors.lastname: de Freitas
authors.forename: Lenio S
authors.initials: LS
authors.lastname: Alvarenga
authors.forename: Luiz
authors.initials: L
authors.lastname: Vieira
authors.forename: Patrícia
authors.initials: P
authors.lastname: Contarini
authors.forename: Elcio
authors.initials: E
authors.lastname: Sato
authors.forename: Annette
authors.initials: A
authors.lastname: Foronda
authors.forename: Ana Luísa
authors.initials: AL
authors.lastname: Hofling-Lima