Therapeutic Failure in Acanthamoeba Keratitis. A Retrospective Observational Study in a Referral Center in Argentina
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Yes
Purpose
To determine the therapeutic failure rate in patients with infectious keratitis caused by Acanthamoeba spp. (AK), defined as those requiring invasive interventions. To describe clinical stage, risk factors at diagnosis, diagnostic methods, and medical treatment used.
Methods
A retrospective cross-sectional observational study conducted at Hospital Italiano de Buenos Aires, Argentina, from 2010 to 2023.
Results
Fifteen patients with AK were included. The therapeutic failure rate was 33.3%, with an average of 253 days to failure. The most common surgical intervention was anterior lamellar keratectomy with conjunctival flap, preserving the globe in all cases. Medical treatments included polyhexamethylene biguanide and chlorhexidine, with an average duration of 171 days in successful cases. Contact lens use was reported in 86.7% of patients as a risk factor. The most effective diagnostic methods were in vivo confocal microscopy (IVCM) and polymerase chain reaction (PCR).
Conclusion
Failure rate was comparable to existing literature. It should be noted that biguanide-only regimens were used since diamidines are unavailable in our region. Conjunctival flap keratectomy proved effective for advanced infections, offering a valuable alternative to penetrating keratoplasty for infectious disease management. PCR and IVCM were the most reliable diagnostic tools. The present evidence suggest that treating acanthamoeba keratitis without diamidines may not increase failure rates and the need of surgery. Further studies with larger cohorts are needed to assess the impact of different variables on outcomes.
Conflict of interest
No
1
Last name
RODRIGUEZ
Initials of first name(s)
S
Department
Ophthalmology
City
Buenos Aires
Country
Argentina
2
Last name
Prini
Initials of first name(s)
D
Department
Ophthalmology
City
Buenos Aires
Country
Argentina
3
Last name
Segretin
Initials of first name(s)
E
Department
Ophthalmology
City
Buenos Aires
Country
Argentina
4
Last name
Garcia
Initials of first name(s)
M, M
Department
Ophthalmology
City
Buenos Aires
Country
Argentina
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