Acanthamoeba keratitis in the last decade. What have we learned?

Abstract

Introduction: Acanthamoeba keratitis continues to be one of the most feared corneal infections due to its severity and capacity to generate irreversible visual sequelae. Despite diagnostic and therapeutic advances, this disease is increasing in our environment every year, related to a growing number of contact lens users. This last decade marked by the COVID-19 pandemic represents an unprecedented historical scenario whose impact must be analyzed from different health points of view. This study aims to describe the epidemiology, clinical presentation, treatment and evolution of Acanthamoeba keratitis in a tertiary hospital in the last 10 years.

Results: The results have been obtained from a total of 13 eyes of 13 patients. This series of cases shows a diagnostic gap during the pandemic period, with a greater number of patients in the previous and post-pandemic stages. The different parameters of clinical presentation, microbiological diagnosis and clinical evolution are analyzed. All patients in our study wore contact lenses. Five of the cases were initially diagnosed in other centers as herpetic keratitis. Seven patients had a pseudo-dendrite as initial presentation, while six cases presented as an annular infiltrate. In all cases, 0.02% chlorhexidine eye drops were prescribed and this was associated with 0.1% propamidine in 11 cases. The results were variable, achieving an improvement in visual acuity in 10 of the cases.

Conclusion: This is a study on an emerging disease and with increasingly advanced knowledge and use of diagnostic and therapeutic tools in the historical context of a pandemic. This text attempts to shed light on the different forms of presentation and management of cases of Acanthamoeba keratitis.