Prognostic factors in Acanthamoeba keratitis.
OBJECTIVE
To assess the prognostic factors influencing visual prognosis and length of treatment after acanthamoeba keratitis (AK).


METHODS
Forty-two AK eyes of 41 patients treated between 1999 and 2006 were included.


METHODS
A diagnosis of AK was made on the basis of culture results with a corresponding clinical presentation. We calculated the prognostic effect of the various factors on final visual acuity and the length of treatment. Multivariate regression analysis was used to adjust for the simultaneous effects of the various prognostic factors.


RESULTS
Mean follow-up was 19.7 ± 21.0 months. Sixty-four percent of cases had > 1 identified risk factor for AK, the most common risk factor being contact lens wear (92.9% of eyes). At presentation, median best spectacle corrected visual acuity (BCVA) was 20/200 (20/30 to Hand Motion [HM]) that improved after treatment to 20/50 (20/20 to Counting Fingers [CF]). Infection acquired by swimming or related to contact lenses had significantly better final BCVA (p = 0.03 and p = 0.007, respectively). Neuritis and pseudodendrites were also associated with better final BCVA (p = 0.04 and p = 0.05, respectively). Having had an epithelial defect on presentation and having been treated with topical steroid were associated with worse final best spectacle corrected visual acuity (BSCVA) (p = 0.0006 and p = 0.04). Multivariate regression analysis found a good initial visual acuity (p = 0.002), infections related to swimming (p = 0.01), the absence of an epithelial defect (p = 0.03), having been treated with chlorhexidine (p = 0.05), and not having receive steroids (p = 0.003) to significantly forecast a good final BCVA.


CONCLUSIONS
We identified several prognostic factors that can help clinicians evaluate the expected visual damage of the AK infection and thus tailor treatment accordingly.
Department of Ophthalmology, Toronto Western Hospital, University of Toronto, Toronto, Ont. Igor@Dr-Kaiserman.com
Igor
I
Kaiserman
Irit
I
Bahar
Penny
P
McAllum
Sathish
S
Srinivasan
Uri
U
Elbaz
Allan R
AR
Slomovic
David S
DS
Rootman
D015823:Acanthamoeba Keratitis / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D003263:Contact Lenses, Hydrophilic / Q000469:parasitology; D004209:Disposable Equipment; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult
D000981:Antiprotozoal Agents