CLINICAL FEATURES, DIAGNOSIS, THE RESULTS OF THERAPEUTIC AND SURGICAL TREATMENT OF ACANTHAMOEBIC KERATITIS

Purpose: to describe our experience in Acanthamoeba keratitis diagnostics and treatment in the FGBNU Research Institute of eye diseases, Moscow.

Patients and Methods. We observed 24 patients (25 eyes) with the Acanthamoeba keratitis (AK). The age ranged from 18 to 47 years. All patients, except one, were contact lenses wearers. Clinical signs included superficial epithelial-stromal lesions in 8 patients (8 eyes), stromal forms of AK- in 16 patients (17 eyes), and mixed keratitis in 9 (9 eyes). We used confocal microscopy, conjunctival smearing and blood immunofluorescent analysis for HSV types I and II. 8 patients (8 eyes) underwent penetrating keratoplasty (PKP) and their corneal buttons were morphologically examined. AK treatment included 2 biguanid antiseptics — a PHMB ("Comfort-drops" — solution for contact lenses care) and 0.025% solution of a chlorhexidini bigluconati, or "Vitabact" in frequent instillations. We also used Diflucan solution 0.2% instillations — 6–8 times a day in, and Orungal or Diflucan per os (200 mg once a day). Eye drops of aminoglycozide or fluorhinolon groups were added to the treatment as well. In the cases of mixed Acanthamoeba and HSV keratitis we used anti-herpetic medications (Poludan, Acyclovir).

Results. Cysts were found with confocal microscopy in 66% examined patients, and in 75% of the corneal buttons after keratoplasty. 15 cases (60%) healed with various intensity opacities. We removed corneal epithelium in 2 patients with poor effect of the medication treatment. 8 patients (8 eyes) underwent PKP with transparent (2 patients) and a semi-transparent engraftment (2 patients), in 4 cases (4 eyes) AK recurrences had occurred, what required repeated surgery. Long persistence of Acanthamoeba cysts in the cornea after clinical recovery caused the admission of 2 antiseptic biguanids eye drops for 6–20 months in all patients. There were no recurrences in the group of patients during the observation period (range 1 to 6 years).

Conclusion. AK is an extremely dangerous cornea disease , in most cases developing with contact lenses. Effective instrumental diagnostics methods of AK are confocal microscopy and morphological examination of distant corneal discs. Often, AK combined with a herpetic and bacterial infection (mixed keratitis). AK treatment requires the active use of several antiseptic agents with amoebicidal action, mycostatic drugs, antibiotics and other drugs. Therapeutic keratoplasty, often necessary in AK, accompanied by a high risk of complications and relapses of the disease, but in 50% cases, good results were achieved.

Acanthamoeba keratitis, mixed keratitis, confocal microscopy, Acanthamoeba cysts, penetrating keratoplasty, epithelial debridement

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