Systemic Miltefosine as an Adjunct Treatment of Progressive Acanthamoeba Keratitis

Area of Science:

• Ophthalmology
• Infectious Diseases
• Pharmacology

Background:

• Acanthamoeba keratitis (AK) is a serious microbial eye infection that can lead to vision loss.
• Standard treatments for AK can be challenging, especially in progressive or recalcitrant cases.
• Oral miltefosine (MLT) is an antiparasitic drug with potential applications in treating resistant infections.

Observation:

• This retrospective case series evaluated the use of oral MLT as an adjunct therapy for six patients with progressive AK.
• Patients received MLT in conjunction with standard medical treatments.
• Treatment duration and outcomes varied among the patients.

Findings:

• Four out of six patients experienced disease progression despite MLT treatment, with three requiring therapeutic keratoplasty.
• Two patients showed improvement within one week of initiating MLT, subsequently undergoing optical penetrating keratoplasty.
• Corneal button cultures were negative post-keratoplasty, and grafts remained clear with good visual acuity (≥20/40).

Implications:

• Oral MLT may be a potential adjunctive treatment option for severe or recalcitrant cases of Acanthamoeba keratitis.
• The use of oral MLT might be associated with severe inflammatory reactions, requiring careful monitoring.
• Further clinical studies are essential to confirm the efficacy and understand the variable clinical responses to oral MLT in AK treatment.