PROGNOSTIC FACTORS IN ACANTHAMOEBA KERATITIS
Published 2023 - 27th ESCRS Winter Meeting
Reference: O52 | Type: Free Paper Submission | DOI: 10.82333/05a4-fb76
Authors: Rodrigo Vilares Morgado* 1 , Carolina Madeira 2 , Raul Moreira 3 , Luis Torrão 3 , Fernando Falcão-Reis 1 , João Pinheiro-Costa 1
1Department of Ophthalmology,Centro Hospitalar Universitário de S. João,Porto,Portugal;Department of Surgery and Physiology,Faculty of Medicine,Porto,Portugal, 2Department of Ophthalmology,Centro Hospitalar Vila Nova de Gaia e Espinho,Porto,Portugal, 3Department of Ophthalmology,Centro Hospitalar Universitário de S. João,Porto,Portugal
Purpose
To establish predictors of poor prognosis for visual and morphological outcomes in patients with Acanthamoeba Keratitis (AK).
Setting
Retrospective single-center study that took place in Centro Hospitalar Universitário S. João (Porto, Portugal), a tertiary university hospital.
Methods
We included 34 cases of AK diagnosed by real-time polymerase chain reaction (RT-PCR) between March 2010 and August 2017, who were followed at the Cornea Clinic of our Ophthalmology Department. We reviewed the clinical charts of these patients and collected data regarding their demographic information, best corrected visual acuity (BCVA), clinical findings, therapeutic regimen, final visual outcomes and complications of the disease. Poor visual outcome was defined as a final BCVA ≥ 1 logMAR unit.
Results
A total of 34 eyes from 29 patients diagnosed with AK were included in this study. All patients were contact lens (CL) wearers. Regarding visual outcomes, eyes with poor visual outcome were diagnosed later after initial symptoms (28 [4-150] vs 14 [1-60] days; p=0.01). Poor visual outcome was also associated with older age at diagnosis (37 [23-66] vs 33 [19-43] years; p=0.04), lower initial BCVA (1.3 [0.3-2.0] vs 0.5 [0.1-2.0] logMAR units; p=0.02) and presence of stromal infiltrates (41.2 vs 7.1%; p=0.03) in slit lamp examination. 35.3% of the included eyes underwent surgical epithelial debridement and 29.4% keratoplasty. Those who underwent surgical debridement had a better visual outcome (p=0.002). In a multivariable analysis that included age, initial visual acuity, time of evolution before diagnosis and treatment initiation (≤15 days vs >15 days), and surgical epithelium debridement, a time of evolution >15 days (p=0.04) and absence of surgical epithelium removal (p=0.02) remained significantly associated with worse visual outcomes.
Conclusion
In AK, establishing poor prognostic factors is vital to identify high-risk patients who might need a more aggressive treatment. In our cohort, a delayed diagnosis and the absence of surgical epithelial debridement were significantly associated with worse final visual outcomes. Thus, early diagnosis with RT-PCR confirmation and prompt medical and surgical treatment may significantly improve visual outcomes in these patients.