Successful treatment of chronic stromal acanthamoeba keratitis with oral voriconazole monotherapy.
OBJECTIVE
To describe the treatment of chronic stromal Acanthamoeba keratitis (AK) with oral voriconazole monotherapy.


METHODS
All cases of chronic stromal AK recalcitrant to traditional therapy subsequently treated with systemic voriconazole seen at the University of Illinois Eye and Ear Infirmary between June 2003 and July 2009 were reviewed for clinical presentation, clinical course, and outcome.


RESULTS
Three eyes of 2 patients were identified with culture-confirmed chronic stromal AK unresponsive to traditional antiacanthamoebal therapies, requiring topical corticosteroids to maintain corneal clarity. Oral voriconazole 200 mg twice daily achieved a rapid but transient reduction of inflammation and elimination of corticosteroid dependency but, in both patients, recrudesced approximately 6 weeks after its discontinuation. Subsequent repeated and/or extended use of oral voriconazole alone resulted in complete resolution ranging from 7 to 11 months off all medications with final best-corrected visual acuity ranging from 20/20 to 20/25.


CONCLUSIONS
Recalcitrant chronic Acanthamoeba stromal keratitis was successfully treated with extended systemic voriconazole administration with good preservation of vision. The clinical resolution of chronic stromal keratitis in our 2 cases suggests that voriconazole may have a larger role in the treatment of AK.
Tu
Elmer Y
EY
Department of Ophthalmology and Visual Science, University of Illinois at Chicago, 60612, USA. etu@uic.edu
Joslin
Charlotte E
CE
Shoff
Megan E
ME
D015823:Acanthamoeba Keratitis / Q000188:drug therapy*; D000284:Administration, Oral; D000293:Adolescent; D000981:Antiprotozoal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002908:Chronic Disease; D003319:Corneal Stroma / Q000469:parasitology*; D005260:Female; D006801:Humans; D008297:Male; D011743:Pyrimidines / Q000008:administration & dosage / Q000627:therapeutic use*; D014230:Triazoles / Q000008:administration & dosage / Q000627:therapeutic use*; D065819:Voriconazole
D000981:Antiprotozoal Agents; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole