A REVIEW OF 72 CONSECUTIVE CASES OF ACANTHAMOEBA-KERATITIS, 1984-1992

A review of consecutive cases of Acanthamoeba keratitis presenting since 1984 was undertaken in order to assess prognostic factors, the success of culture procedures and the outcome of medical and surgical management, with reference to current clinical practice. Seventy-two consecutive cases (77 eyes) of Acanthamoeba keratitis have been managed. Sixty-four patients were contact lens wearers, 28 of these wearing disposable lenses. Superficial corneal involvement and perineural infiltrates mere common in those diagnosed less than a month after first symptoms, designated `early' presentation. Ring infiltrates and ulceration with stromal lysis characterised those presenting at 1-2 months (`intermediate') or after 2 months (`late'); these groups also progressed more frequently to hypopyon, scleritis, glaucoma and cataract formation. Positive corneal cultures were obtained in 10 of 14 (71%) intermediate and 17 of 23 (74%) late cases; early cases underwent epithelial biopsy but formal trephine biopsy was not usually justified (1 of 35 cases) and only 19 of 35 (54%) were tissue-positive. Microbial coisolates were obtained from 20 corneas. Thirty-four penetrating keratoplasties were performed in 23 eyes, 21 whilst inflamed and 13 when quiet. Of 13 failures in inflamed eyes, 9 were due to recurrence of Acanthamoeba infection. Medical cure is known to have been achieved in 64 of 73 (88%) eyes, 4 of the original 77 having been lost to follow-up abroad. Fifty-eight of 73 eyes (79%) achieved a final visual acuity of 6/12, and of the culture-positive cases, 32 of 46 (70%) achieved 6/12. Since 1984 an effective biguanide-propamidine treatment combination has been introduced, cases have been diagnosed increasingly early and consequently the time taken for medical cure has decreased. The prognosis of this potentially blinding keratitis has improved due to heightened clinical suspicion resulting in early diagnosis, a rigorous scheme of investigation and proven management strategies.