title: Treatment of acanthamoeba keratitis with intravenous pentamidine before therapeutic keratoplasty.
abstract: OBJECTIVE
  The aim of this study was to evaluate the outcome of pretreatment of Acanthamoeba keratitis with intravenous pentamidine (IVP) before therapeutic keratoplasty (TKP).
  
  
  METHODS
  A retrospective chart review was performed of the medical records of every patient treated with IVP before TKP for Acanthamoeba keratitis at a single, tertiary care eye center between January 1, 2002, and December 31, 2012. The main outcome measures were microbiological cure, graft survival, and visual outcome.
  
  
  RESULTS
  Eight eyes of 7 patients met the inclusion criteria. Preoperatively, all 8 eyes had failed traditional antiamoebic therapy, including 5 eyes with recurrent infections after previous TKP. The patients were treated with IVP (190-400 mg/d) for a median of 14 days (range, 7-26 days). After 8 TKP, a microbiological cure was achieved, and a clear graft was maintained in 5 (62.5%) eyes during a mean follow-up interval of 31.2 months (range, 1.0-95.7 months). Repeat TKP in 3 eyes with recurrent Acanthamoeba keratitis resulted in 2 additional microbiological cures and 1 more clear graft. The final best-corrected visual acuity was ≥20/40 in 5 (62.5%) eyes and worse than 20/200 in 3 eyes. Overall, the final vision was improved in 6 (75.0%) eyes, remained the same in 1 (12.5%) eye, and was worse in 1 (12.5%) eye.
  
  
  CONCLUSIONS
  The adjunctive use of IVP before TKP may assist with the achievement of microbiological cure, clear graft, and good visual outcome in a majority of eyes with Acanthamoeba keratitis.
authors.affiliation: *Department of Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine, Iowa City, IA; and †Department of Ophthalmology, Kansas University Medical Center, Kansas City, KS.
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Sacher
authors.forename: Michael D
authors.initials: MD
authors.lastname: Wagoner
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Goins
authors.forename: John E
authors.initials: JE
authors.lastname: Sutphin
authors.forename: Mark A
authors.initials: MA
authors.lastname: Greiner
authors.forename: Anna S
authors.initials: AS
authors.lastname: Kitzmann
mesh_terms: D015823:Acanthamoeba Keratitis / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000981:Antiprotozoal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D007262:Infusions, Intravenous; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D010419:Pentamidine / Q000008:administration & dosage / Q000627:therapeutic use*; D012008:Recurrence; D012189:Retrospective Studies; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult
chemical_list: D000981:Antiprotozoal Agents; D010419:Pentamidine