Clinical Outcomes And Prognostic Factors In Acanthamoeba Keratitis
Published 2024 - 42nd Congress of the ESCRS
Reference: FP11.02 | Type: Free paper | DOI: 10.82333/q9bd-a027
Authors: Ana Margarida Ferreira* 1 , Rodrigo Vilares-Morgado 2 , Pedro Marques-Couto 1 , Carolina Madeira 3 , Raúl Moreira 1 , Luís Torrão 2 , Pedro Neves-Cardoso 2 , Ana Maria Cunha 2 , Sandra Rebelo 4 , João Pinheiro-Costa 2
1Ophthalmology,ULS São João,Porto,Portugal, 2Ophthalmology,ULS São João,Porto,Portugal;Department of Surgery and Physiology,Faculty of Medicine, University of Porto,Porto,Portugal, 3Ophthalmology,ULS Vila Nova de Gaia/Espinho,Vila Nova de Gaia,Portugal, 4Clinical Pathology,ULS São João,Porto,Portugal;Biomedicine,Faculty of Medicine, University of Porto,Porto,Portugal
Purpose
To report clinical findings and prognostic factors for visual and morphological outcomes in patients with Acanthamoeba keratitis (AK).
Setting
Single-center, retrospective, longitudinal study of 51 cases of AK diagnosed by real-time polymerase chain reaction (RT-PCR) between March 2010 and October 2022.
Methods
The primary outcome was the final best corrected visual acuity (BCVA). Poor visual outcome was defined as a final BCVA ≥ 1 logMAR unit, while good visual outcome was defined as a final BCVA < 1 logMAR unit. Eyes from these two groups were compared, regarding demographic and initial clinical variables, anti-Acanthamoeba treatment used, and complications of the disease. Early diagnosis was defined as ≤ 14 days from symptom onset to diagnostic confirmation and initiation of Acanthamoeba medical treatment. Multivariable logistic regression was used to determine predictors of poor visual outcome. A total of 51 eyes from 46 patients diagnosed with AK, all contact lens (CL) wearers, were included in this study.
Results
Average follow-up was 39.0±30.2 [range 14–120] months. 31 eyes (60.8%) presented good visual outcome, with a lower baseline age (30.5±9.0 vs 42.3±15.8; p=0.02), better initial BCVA (0.8±0.7 vs 1.3±0.9 logMAR units; p=0.047), higher rate of early diagnosis (45.2% vs 5.6%; p=0.004), and higher rate of therapeutic epithelial debridement (64.5% vs 10%; p<0.001). 20 eyes (39%) presented poor visual outcome, with 12 eyes undergoing evisceration/enucleation (23.5%). These 20 eyes presented a higher rate of complications (90% vs 61%; p=0.03). In multivariable analysis, early diagnosis of AK (OR 19.78; 95%CI 2.07–189.11; p=0.010) and therapeutic epithelial debridement (OR 19.02; 95%CI 3.27–110.57; p=0.001) were associated with a good visual outcome.
Conclusions
In the present study, poor visual outcome was present in 39 % of affected eyes. Early AK diagnosis (≤14 days from symptom onset) and therapeutic epithelial debridement were associated with good final visual outcome.