Factors Influencing the Diagnostic Accuracy of Laser-Scanning In Vivo Confocal Microscopy for Acanthamoeba Keratitis
Purpose: To determine the factors that influence the sensitivity and specificity of laser-scanning in vivo confocal microscopy (IVCM) for diagnosing Acanthamoeba keratitis (AK). Methods: This retrospective, controlled study included 28 eyes of 27 patients with AK and 34 eyes of 34 patients with bacterial keratitis (as the control group). All patients had undergone corneal imaging with a laser-scanning IVCM (Heidelberg Retina Tomograph 3 with the Rostock Cornea Module). The IVCM images were independently evaluated by 2 experienced and 2 inexperienced masked observers. Sensitivity and specificity of IVCM for diagnosing AK and the effects of various clinical and imaging parameters on the sensitivity were then investigated. Results: Overall, IVCM had average sensitivity and specificity of 69.7% ± 2.5% and 97.1% ± 4.2% for experienced observers and 59.0% ± 7.6% and 92.7% ± 10.4% for inexperienced observers, respectively. However, the sensitivity did not show any significant association with the duration of disease, size of ulcer, depth of involvement, culture results, or cyst morphology. Although interobserver agreement was good (κ = 0.60, P
This patient with recurrent unilateral ocular complaints, a lid lesion, and keratitis unresponsive to numerous medications as well as a negative work-up for infectious agents leaves us with numerous diagnostic possibilities. These include: viral shedding from the lid lesion as with molluscum, eyelid deformity with corneal exposure, limbal stem cell deficiency of uncertain etiology, ocular surface dysplasia or neoplasia, superior limbic keratoconjunctivitis, vernal keratoconjunctivitis, herpes group viruses, Acanthamoeba keratitis, eyelid foreign body, medicamentosa, and many others.
Eye, Published online: 25 September 2019; doi:10.1038/s41433-019-0589-6Acanthamoeba keratitis in Australia: demographics, associated factors, presentation and outcomes: a 15-year case review
To report the clinical and microbiological features of Acanthamoeba keratitis (AK) related to contact lens use in a tertiary hospital in China.
Conclusions: In an in vitro assay, voriconazole reduced the cysticidal activity of 2 commonly used antiamoebic drugs. Although the in vivo drug interactions could be different, these observations may be useful in cases of nonhealing Acanthamoeba keratitis being treated with combination therapies that include voriconazole.
CONCLUSION: PHMB 0.02% monotherapy for the initial treatment of AK is as effective as biguanide+diamidine combination therapy. Chlorhexidine monotherapy was too infrequent for comparison. The outcome data are the most detailed available. PMID: 31401556 [PubMed - as supplied by publisher]
New England Journal of Medicine,Volume 381, Issue 3, Page 274-274, July 2019.
ConclusionPKP à chaud within 5.3 months after first symptoms of therapy-resistant AK seems to result in better final BCVA than delayed graft surgery if the disease is resistant to a classical topical triple therapy. In addition, early PKP may have a favorable impact on epithelial healing and graft survival.FundingWe thank the Alexander von Humboldt Foundation for supporting the work of Prof. N. Szentm áry at the Department of Ophthalmology of Saarland University Medical Center in Homburg/Saar, Germany. We thank the University of Saarland for funding the medical writing assistance and the Rapid Service Fe...
Eye, Published online: 10 July 2019; doi:10.1038/s41433-019-0482-3Clinical features and serial changes of Acanthamoeba keratitis: an in vivo confocal microscopy study
Nick Humphreys, of Shropshire, noticed a scratch on his right eye in January 2018. By March, he had gone blind because of Acanthamoeba keratitis, a parasitic infection.
No abstract available