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Free-Living Amoebae Keratitis.

Antonio Pinna1, Tiziana Porcu, Francesco Boscia

  • 1*Department of Surgical, Microsurgical, and Medical Sciences, Ophthalmology Unit, University of Sassari, Sassari, Italy; †Azienda Opedaliero-Universitaria di Sassari, Unità Operativa di Oculistica, Sassari, Italy; and ‡Department of Biomedical Sciences, University of Sassari, Sassari, Italy.

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|May 10, 2017
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Summary

Free-living amoebae (FLA) other than Acanthamoeba can cause keratitis. Early diagnosis and treatment with polyhexamethylene biguanide (PHMB) are crucial for successful outcomes in FLA keratitis.

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Area of Science:

  • Ophthalmology
  • Infectious Diseases
  • Microbiology

Background:

  • Free-living amoebae (FLA) are increasingly recognized as causative agents of microbial keratitis.
  • Contact lens wear is a significant risk factor for FLA keratitis.

Purpose of the Study:

  • To detail the diagnostic findings, clinical characteristics, and treatment outcomes for 43 patients with culture-proven FLA keratitis.
  • To investigate the spectrum of FLA causing keratitis beyond Acanthamoeba.

Main Methods:

  • A prospective case series involving 43 patients with suspected amoebic keratitis.
  • Corneal scrapings were analyzed using non-nutrient agar cultures and polymerase chain reaction (PCR) for amoebic identification.
  • Treatment involved topical 0.02% polyhexamethylene biguanide (PHMB) eye drops.

Main Results:

  • Forty-three cases of culture-positive FLA keratitis were identified; 95% involved contact lens wearers.
  • Identified FLA included Acanthamoeba, Hartmannella, and vahlkampfiid amoebae, with morphological identification confirmed by PCR.
  • Early-stage keratitis treated with PHMB showed full recovery in 38 eyes; advanced cases had infection control but resulted in visual deterioration due to corneal scarring.

Conclusions:

  • Acanthamoeba is not the sole cause of amoebic keratitis; Hartmannella and vahlkampfiid amoebae are also significant pathogens.
  • The findings suggest potential geographical variations in the prevalence of different FLA causing keratitis.
  • Prompt diagnosis and appropriate antiamoebic therapy are essential for successful management and visual preservation in FLA keratitis.