title: Practice patterns and opinions in the treatment of acanthamoeba keratitis.
abstract: OBJECTIVE
  Management of acanthamoeba keratitis remains challenging for ophthalmologists. We conducted a survey of members of The Cornea Society to elicit expert opinions on the diagnosis and treatment of acanthamoeba keratitis.
  
  
  METHODS
  An online survey was sent to all subscribers of The Cornea Society via the kera-net listserv. Descriptive statistics were performed.
  
  
  RESULTS
  Eighty-two participants completed the online survey. Of the 82 respondents, 76.8% included the combination of clinical examination and culture in their diagnostic strategy and 43.9% used confocal microscopy. Most respondents (97.6%) had used combination therapy with multiple agents to treat acanthamoeba keratitis at some point in the past, whereas a smaller proportion (47.6%) had ever used monotherapy. Respondents most commonly chose polyhexamethylene biguanide as the ideal choice for monotherapy (51.4%), and dual therapy with a biguanide and diamidine as the ideal choice for combination therapy (37.5%). The majority of respondents (62.2%) reported using topical corticosteroids at least some of the time for acanthamoeba keratitis. Keratoplasty was an option considered by most respondents (75.6%), although most (85.5%) would only perform surgery after medical treatment failure.
  
  
  CONCLUSIONS
  There was a wide range of current practice patterns for the diagnosis and treatment of acanthamoeba keratitis. The lack of sufficiently powered comparative effectiveness studies and clinical trials makes evidence-based decision-making for this disease difficult.
authors: F.I. Proctor Foundation, University of California, San Francisco, San Francisco, CA 94143-0944, USA.
authors: Catherine E
authors: CE
authors: Oldenburg
authors: Nisha R
authors: NR
authors: Acharya
authors: Elmer Y
authors: EY
authors: Tu
authors: Michael E
authors: ME
authors: Zegans
authors: Mark J
authors: MJ
authors: Mannis
authors: Bruce D
authors: BD
authors: Gaynor
authors: John P
authors: JP
authors: Whitcher
authors: Thomas M
authors: TM
authors: Lietman
authors: Jeremy D
authors: JD
authors: Keenan
mesh_terms: D015823:Acanthamoeba Keratitis / Q000175:diagnosis* / Q000628:therapy*; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000627:therapeutic use*; D001645:Biguanides / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006801:Humans; D015948:Keratoplasty, Penetrating; D008297:Male; D018613:Microscopy, Confocal; D009885:Ophthalmology; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D000981:Antiprotozoal Agents; D001645:Biguanides