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The incidence of severe complications in acanthamoeba keratitis: Qualitative and quantitative systematic assessment
Matteo Posarelli1, Maria Laura Passaro2, Fabio Claudio Avolio3
1St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK; Ophthalmology Unit of the Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy.
Abstract:
Acanthamoeba keratitis (AK) is a rare, sight-threating corneal infection. The disease is challenging to diagnose and treat, and the amoeba can rapidly encyst, persisting in the tissue and causing recurrences. Medical therapy is conventionally considered the first line treatment, but advanced cases could require more invasive treatments like a "chaud" corneal transplant. We review the incidence of severe complications in patients affected by AK. Of 439 reports screened, 158 met our inclusion criteria. Incidence of severe complications was low, with 2.21 % patients developing perforation, 1 % requiring evisceration/enucleation and less than 1 % developing endophthalmitis. Corneal transplantation was required in 16.68 % of the cases. According to our results, and considering the reported incidences of these complications in other infectious keratitis, AK patients have an overall low risk of developing perforation, endophthalmitis, and enucleation/evisceration. Nevertheless, data available in the literature remain poor, and further randomized control trials are needed to confirm our findings.
Insights
Acanthamoeba keratitis (AK) is a severe eye infection. This review found a low incidence of severe complications like perforation or vision loss in AK patients, though corneal transplants are common.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Microbiology
Background:
- Acanthamoeba keratitis (AK) is a rare but sight-threatening corneal infection.
- AK is difficult to diagnose and treat, with a propensity for recurrence due to amoebic encystment.
- While medical therapy is standard, severe cases may necessitate invasive procedures like corneal transplantation.
Purpose of the Study:
- To review the incidence of severe complications in patients with Acanthamoeba keratitis.
- To compare the risk of severe outcomes in AK with other infectious keratitis cases.
- To identify gaps in current literature regarding AK complications.
Main Methods:
- Systematic review of published reports on Acanthamoeba keratitis.
- Screening of 439 reports, with 158 meeting inclusion criteria for analysis.
- Extraction and analysis of data on severe complications such as perforation, evisceration/enucleation, endophthalmitis, and corneal transplantation.
Main Results:
- The incidence of severe complications was low: 2.21% for perforation, 1% for evisceration/enucleation, and <1% for endophthalmitis.
- Corneal transplantation was required in 16.68% of AK cases.
- Compared to other infectious keratitis, AK patients demonstrated a lower risk of perforation, endophthalmitis, and enucleation/evisceration.
Conclusions:
- Acanthamoeba keratitis patients generally face a low risk of severe sight-threatening complications like perforation and endophthalmitis.
- Despite low complication rates, corneal transplantation remains a significant requirement in a notable percentage of AK cases.
- Further robust research, including randomized controlled trials, is essential to validate these findings due to limitations in existing literature.
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