Acanthamoeba Keratitis in Egypt: Characteristics and Treatment Outcomes

Mohamed H Nasef, Sharif Y El Emam, Mohamed S ElShorbagy, Waleed A Allam Ophthalmology Department, Tanta University, Faculty of Medicine, Tanta, EgyptCorrespondence: Mohamed H NasefOphthalmology Department, Tanta University’s Faculty of Medicine, Tanta, EgyptTel +20 100 2826555Email mohamed...

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Autores principales:	Nasef MH, El Emam SY, ElShorbagy MS, Allam WA
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2021
Materias:	acanthamoeba keratitis contact lenses confocal microscopy Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/5f7747281ccf4e6a8f7a4988ead9c801
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spelling	oai:doaj.org-article:5f7747281ccf4e6a8f7a4988ead9c8012021-12-02T14:06:16ZAcanthamoeba Keratitis in Egypt: Characteristics and Treatment Outcomes1177-5483https://doaj.org/article/5f7747281ccf4e6a8f7a4988ead9c8012021-03-01T00:00:00Zhttps://www.dovepress.com/acanthamoeba-keratitis-in-egypt-characteristics-and-treatment-outcomes-peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483Mohamed H Nasef, Sharif Y El Emam, Mohamed S ElShorbagy, Waleed A Allam Ophthalmology Department, Tanta University, Faculty of Medicine, Tanta, EgyptCorrespondence: Mohamed H NasefOphthalmology Department, Tanta University’s Faculty of Medicine, Tanta, EgyptTel +20 100 2826555Email mohamed.nasef@med.tanta.edu.egPurpose: To study the predisposing factors, clinical manifestations, and treatment outcome of patients with Acanthamoeba keratitis (AK) at Tanta University’s Ophthalmology Hospital in Tanta, Egypt.Methods: A retrospective study of 42 patients (44 eyes) with Acanthamoeba keratitis who had medical records available for review over 4 years.Results: Forty-four eyes of 42 patients were treated for AK over the study period. In 29 eyes (65.8%), AK was related to contact lens wear. Severe ocular pain was the main presenting symptom in 38 eyes (86.3%). The most common ocular signs were radial perineural corneal infiltrates (65.9%), pseudo-dendrites (43.2%), ring infiltrates (45.5%), and diffuse stromal infiltration (59%). Acanthamoeba was detected by culture, smear, and in-vivo confocal microscopy (IVCM) in 25 eyes (56.8%), while in 19 eyes (43.2%) the diagnosis was based solely on the clinical findings. IVCM was effective in detection of Acanthamoeba in cases with early presentation, while culture was more sensitive in late presentation with corneal melting. The mean duration of treatment was 73.3 ± 23.7 days. Surgical intervention in the form of tectonic grafts or amniotic membrane transplant was required in five cases (11.3%) due to progressive corneal thinning and perforation. Seventeen patients (38.6%) had 0.2 or better final best-corrected visual acuity after treatment.Conclusion: The diagnosis of AK remains a major challenge for most ophthalmologists. Contact lens abuse is the major risk factor. Early diagnosis and appropriate treatment of AK with biocidal agents can improve the final outcome and help avoid surgical intervention. IVCM is an excellent tool for early diagnosis of AK.Keywords: acanthamoeba, keratitis, contact lenses, confocal microscopyNasef MHEl Emam SYElShorbagy MSAllam WADove Medical Pressarticleacanthamoebakeratitiscontact lensesconfocal microscopyOphthalmologyRE1-994ENClinical Ophthalmology, Vol Volume 15, Pp 1339-1347 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	acanthamoeba keratitis contact lenses confocal microscopy Ophthalmology RE1-994
spellingShingle	acanthamoeba keratitis contact lenses confocal microscopy Ophthalmology RE1-994 Nasef MH El Emam SY ElShorbagy MS Allam WA Acanthamoeba Keratitis in Egypt: Characteristics and Treatment Outcomes
description	Mohamed H Nasef, Sharif Y El Emam, Mohamed S ElShorbagy, Waleed A Allam Ophthalmology Department, Tanta University, Faculty of Medicine, Tanta, EgyptCorrespondence: Mohamed H NasefOphthalmology Department, Tanta University’s Faculty of Medicine, Tanta, EgyptTel +20 100 2826555Email mohamed.nasef@med.tanta.edu.egPurpose: To study the predisposing factors, clinical manifestations, and treatment outcome of patients with Acanthamoeba keratitis (AK) at Tanta University’s Ophthalmology Hospital in Tanta, Egypt.Methods: A retrospective study of 42 patients (44 eyes) with Acanthamoeba keratitis who had medical records available for review over 4 years.Results: Forty-four eyes of 42 patients were treated for AK over the study period. In 29 eyes (65.8%), AK was related to contact lens wear. Severe ocular pain was the main presenting symptom in 38 eyes (86.3%). The most common ocular signs were radial perineural corneal infiltrates (65.9%), pseudo-dendrites (43.2%), ring infiltrates (45.5%), and diffuse stromal infiltration (59%). Acanthamoeba was detected by culture, smear, and in-vivo confocal microscopy (IVCM) in 25 eyes (56.8%), while in 19 eyes (43.2%) the diagnosis was based solely on the clinical findings. IVCM was effective in detection of Acanthamoeba in cases with early presentation, while culture was more sensitive in late presentation with corneal melting. The mean duration of treatment was 73.3 ± 23.7 days. Surgical intervention in the form of tectonic grafts or amniotic membrane transplant was required in five cases (11.3%) due to progressive corneal thinning and perforation. Seventeen patients (38.6%) had 0.2 or better final best-corrected visual acuity after treatment.Conclusion: The diagnosis of AK remains a major challenge for most ophthalmologists. Contact lens abuse is the major risk factor. Early diagnosis and appropriate treatment of AK with biocidal agents can improve the final outcome and help avoid surgical intervention. IVCM is an excellent tool for early diagnosis of AK.Keywords: acanthamoeba, keratitis, contact lenses, confocal microscopy
format	article
author	Nasef MH El Emam SY ElShorbagy MS Allam WA
author_facet	Nasef MH El Emam SY ElShorbagy MS Allam WA
author_sort	Nasef MH
title	Acanthamoeba Keratitis in Egypt: Characteristics and Treatment Outcomes
title_short	Acanthamoeba Keratitis in Egypt: Characteristics and Treatment Outcomes
title_full	Acanthamoeba Keratitis in Egypt: Characteristics and Treatment Outcomes
title_fullStr	Acanthamoeba Keratitis in Egypt: Characteristics and Treatment Outcomes
title_full_unstemmed	Acanthamoeba Keratitis in Egypt: Characteristics and Treatment Outcomes
title_sort	acanthamoeba keratitis in egypt: characteristics and treatment outcomes
publisher	Dove Medical Press
publishDate	2021
url	https://doaj.org/article/5f7747281ccf4e6a8f7a4988ead9c801
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Acanthamoeba Keratitis in Egypt: Characteristics and Treatment Outcomes

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