[Clinical management and prognosis in Acanthamoeba keratitis: a retrospective study of 25 cases]

To assess risk factors, clinical characteristics, diagnosis and outcome in patients with Acanthamoeba keratitis.

We reviewed 23 patients (25 eyes) treated for Acanthamoeba keratitis in the XV-XX Hospital between November 1994 and October 2000. Acanthamoeba were found either in corneal scrapings and/or contact lenses and/or storage solutions.

A predisposing factor was found in 22/23 patients: most of them (20/22) were contact lens (CL) wearers, two patients had a recent history of corneal trauma, and 15/23 patients had been treated for presumed herpetic keratitis before examination in our hospital. The average delay between first symptoms and diagnosis was 2 months. All patients were treated with two or three topical antiparasitic eye drops for 2 to 6 months. Five patients received systemic treatment (ketoconazole or itraconazole). Nine eyes received surgical treatment: penetrating keratoplasty in eight cases, conjunctival flap in one case, enucleation in one case. Visual outcome was poor in ten eyes (less than 20/60) because of delayed diagnosis.

Acanthamoeba keratitis is a serious vision-threatening disease. Early diagnosis and treatment are essential for improving visual outcome. Methods such as confocal microscopy and Acanthamoeba-PCR, allowing earlier diagnosis and treatment, will improve the management of Acanthamoeba keratitis.