Acanthamoeba Keratitis Management and Prognostic Factors: A Systematic Review.

Area of Science:

• Ophthalmology
• Infectious Diseases
• Microbiology

Background:

• Acanthamoeba Keratitis (AK) is a severe microbial keratitis.
• Effective management strategies and prognostic factors require review.

Purpose of the Study:

• To review therapeutic and prognostic factors influencing Acanthamoeba Keratitis management.
• To summarize current evidence on AK treatment and prognosis.

Main Methods:

• Systematic literature search of MEDLINE, Web of Science, and Scopus.
• Included studies reporting AK treatment regimens and prognostic factors.
• Followed PRISMA 2020 guidelines and registered in PROSPERO.

Main Results:

• Therapeutic epithelial debridement (TED) with biguanides/diamidines is a strong initial treatment.
• Adjunctive voriconazole or miltefosine may be considered.
• Surgical options like DALK, TPK, and OPK are vital for refractory or advanced AK.
• Prognostic factors include age, delayed diagnosis, corticosteroid use, initial BCVA, and AK stage.

Conclusions:

• Initial TED with biguanides and diamidines is foundational for AK treatment.
• Surgical interventions are crucial for advanced or non-responsive cases.
• Early diagnosis, patient age, and initial visual acuity significantly impact AK prognosis.