title: Non-contact lens use-related Acanthamoeba keratitis in southern Turkey: evaluation of risk factors and clinical features.
abstract: OBJECTIVE
  To assess the diagnostic methods, risk factors, and clinical features of Acanthamoeba keratitis cases in patients who do not wear contact lenses.
  
  
  METHODS
  Medical records of 26 consecutive patients with non-contact lens-related Acanthamoeba keratitis, who were followed up at the tertiary eye care center between May 2010 and May 2012, were analyzed. Laboratory, demographic, and clinical findings were evaluated pertaining to the patients.
  
  
  RESULTS
  Twenty-six non-contact lens-related Acanthamoeba keratitis cases were included in the study. The main risk factors were trauma (group 1, n = 13 patients) and ocular surface disease (group 2, n = 12 patients). One patient had both of the risk factors mentioned above. Overall test results showed that Acanthamoeba positivity rates were 15.3% for direct microscopy, 46.1% for culture, 92.3% for conventional polymerase chain reaction (PCR), and 100% for real-time PCR. The rates of full-thickness corneal involvement and ring-shaped infiltrations were higher in group 2, whereas superficial keratitis and radial keratoneuritis were higher in group 1. The final visual acuities were significantly better in group 1 than group 2 (p<0.025).
  
  
  CONCLUSIONS
  This study is the first regional report from Turkey about Acanthamoeba keratitis in non-contact lens users. A majority of cases admitted to a tertiary eye care center were related to trauma or ocular surface disease. Physician suspicion is critically important for the timely diagnosis of these cases. At this point, molecular diagnostic tests (PCR or real-time PCR) seem to support the clinical diagnosis of Acanthamoeba keratitis with the help of fast and reliable results.
authors.affiliation: 1 Ophthalmology Department, Cukurova University Faculty of Medicine, Adana - Turkey.
authors.forename: Elif
authors.initials: E
authors.lastname: Erdem
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Evcil
authors.forename: Meltem
authors.initials: M
authors.lastname: Yagmur
authors.forename: Fadime
authors.initials: F
authors.lastname: Eroglu
authors.forename: Soner
authors.initials: S
authors.lastname: Koltas
authors.forename: Reha
authors.initials: R
authors.lastname: Ersoz
mesh_terms: D000048:Acanthamoeba / Q000235:genetics / Q000302:isolation & purification*; D015823:Acanthamoeba Keratitis / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D001550:Benzamidines / Q000627:therapeutic use; D002648:Child; D002710:Chlorhexidine / Q000627:therapeutic use; D003261:Contact Lenses; D016054:DNA, Protozoan / Q000032:analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009883:Ophthalmic Solutions; D060888:Real-Time Polymerase Chain Reaction; D012307:Risk Factors; D014421:Turkey / Q000453:epidemiology; D014792:Visual Acuity / Q000502:physiology
chemical_list: D000981:Antiprotozoal Agents; D001550:Benzamidines; D016054:DNA, Protozoan; D009883:Ophthalmic Solutions; C046651:propamidine isethionate; D002710:Chlorhexidine