Acanthamoeba Keratitis Management And Prognostic Factors: A Systematic Review

To review existing evidence on therapeutic and prognostic factors that can influence management of Acanthamoeba Keratitis (AK).

Systematic review

A systematic search was performed across MEDLINE® (via PubMed), Web of Science® and Scopus®, following PRISMA guidelines. Studies reporting AK treatment regiments and prognostic factors were included. After extracting the data from the included articles, the most relevant aspects of medical and surgical treatment, as well as relevant prognostic factors were compared and summarized.

Sixty-one articles were included: nine prospective (3 RCTs) and fifty-two retrospective. Review findings suggest that therapeutic epithelial debridement (TED) followed by an association with biguanides, diamidines and an antibacterial agent is a strong initial treatment option.  Adjunctive topical voriconazole 1% or oral miltefosine may also be considered. Surgical approaches were assessed when medical therapy fails, with DALK playing a key role in cases without deep stromal involvement. Early TPK should be used as salvage therapy, and optical TPK for rehabilitation. Key prognostic factors include older age, delayed diagnosis, corticosteroid use before prompt diagnosis, poor initial BCVA, and AK stage at presentation.

The findings emphasize the importance of early diagnosis and tailored therapeutic strategies in AK management. TED combined with appropriate anti-amoebic therapy  is the foundation of treatment, while surgical intervention is necessary in advanced cases. Prognostic factors such as age, treatment delay, and initial BCVA should be carefully considered to optimize patient outcomes. Future research should focus on improving treatment protocols and exploring novel agents to reduce complications and optimize prognostic.