Posters

Assessment, investigations and management of acanthamoeba keratitis: a 24 month retrospective study from the second largest tertiary eye referral centre in the United Kingdom

Poster Details

First Author: M. Khan UK

Co Author(s): A. Ranganath   A. Aralikatti                 

Abstract Details

Purpose:

Although rare, acanthamoeba keratitis is a potentially devastating sight-threatening ocular infection. The premise of this retrospective study was to explore the assessment and management of this condition at the second largest tertiary eye centre in the united kingdom, over a 24 month period. There are currently no definitive RCOphth guidelines for the management of acanthamoeba keratitis.

Setting:

Birmingham Midland Eye Centre. Birmingham. United Kingdom.

Methods:

A total of 21 patients were identified over a 24 month period with confirmed diagnosis with either PCR and microbiology. A proforma was employed, encompassing a number of parameters, ranging from symptoms at presentation to modality of primary investigation and treatment regime employed.

Results:

The majority of patients were 40 or under (57%) while almost all (20/21) were contact lens wearers. Of the latter, all used soft lenses and the majority (15/21) were monthly contact lens wearers. At presentation, 12/21 of the patients had a visual acuity of 6/24 or worse, while almost half (10/21) exhibited the classical ring infiltrate. All described pain at the first visit. 17/21 had PCR at initial presentation. The treatment strategy varied considerably and included a combination of PHMB, chlorhexidine or brolene. Six patients were prescribed topical steroids at initial presentation.

Conclusions:

There is an inherent lack of evidence base for the management of this devastating sight threatening infection. The lack of uniformity in the treatment strategy employed reflects this. The overwhelming majority of our patients fit the established stereotype i.e. were young contact lens users. Those with delayed diagnosis and and poorer vision at presentation had a worse visual outcome. A worrying number of patients were prescribed topical steroids at initial presentation due to misdiagnosis. Our study highlights the value of PCR in establishing a diagnosis. Robust clinical trials are required to better inform a uniform treatment strategy in the future.

Financial Disclosure:

None