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Acanthamoeba keratitis at a London ophthalmic referral hospital: a two-year retrospective observational study

Poster Details

First Author: J.Hoffman UK

Co Author(s):    S. Verma   H. Jasim   J. Dart              

Abstract Details

Purpose:

Acanthamoeba keratitis (AK) is a rare but severe corneal infection associated with significant morbidity and visual loss. Contact lens (CL) wear is a major risk factor. This study reviewed the clinical features, investigations and management of all Acanthamoeba keratitis cases presenting to Moorfields Eye Hospital, London over two years.

Setting:

Moorfields Eye Hospital, London, UK: a tertiary referral ophthalmic hospital which treats over 100,000 emergency cases per annum.

Methods:

Retrospective observational study. All cases of AK presenting between 1st January 2014 and 31st December 2015 were identified. The definition of AK required at least one of these criteria to be positive: culture, light microscopy of corneal scrape material, PCR, in vivo confocal microscopy (IVCM) or clinical features (perineural infiltrates, pseudodendrites). The main outcome was number of cases per year. Secondary outcomes included how the diagnosis was reached, treatment and outcome, patient characteristics and risk factors amongst CL and non-CL wearers.

Results:

We identified 102 cases (54 in 2014, 48 in 2015). Median age was 31.6 years. 63 cases (61.8%) were female. 96.1% of cases used CL, 78.1% using daily wear planned replacement soft CL. Contact with water and CL was reported by 52.9%. AK was suspected in 51.0% at presentation; the remainder were initially managed as microbial keratitis (25.5%), herpes simplex keratitis (8.2%) or other conditions (13.3%). AK was confirmed by culture and/or PCR (43.1%), IVCM alone (33.3%) or clinical features alone (3.9%). IVCM was positive in 84% of cases. Final BCVA in 13% of cases was worse than 6/18.

Conclusions:

Approximately 1 case of AK presented to our hospital per week over the study period. 96.1% were CL wearers, supporting previous estimates, although nearly two thirds denied any CL contact with water. Initial diagnosis of AK can be difficult; IVCM can play a significant role in aiding the diagnosis.

Financial Disclosure:

NONE

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