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Early Penetrating Keratoplasty À Chaud May Improve Outcome in Therapy-Resistant Acanthamoeba Keratitis

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Abstract

Introduction

Long-standing acanthamoeba keratitis (AK) may result in corneal neovascularization, extension of the infiltrate to the limbus or sclera, broad peripheral synechiae, mature cataract or ischemic posterior segment inflammation. We investigated the impact of early emergency penetrating keratoplasty (PKP) in therapy-resistant cases among the patients of a highly specialized tertiary care center.

Methods

In this retrospective, observational cohort within a single institution, we collected data on best-corrected visual acuity (BCVA), epithelial wound healing, graft survival and secondary complications of AK patients who underwent PKP. A total of 23 eyes of 23 patients diagnosed with acute, therapy-resistant AK between 2006 and 2015 were enrolled. Postoperative combined topical treatment was tapered for 6–9 months.

Results

Eyes were grouped based on preoperative disease duration as shorter (group 1) or longer (group 2) than the median. The median was 5.3 (0.66–36) months. The BCVA in group 1 (20/44 ± 20/18; 0.32 ± 0.18 logMAR) was significantly better than in group 2 (20/1200 ± 20/1133; 1.28 ± 0.89; logMAR); p = 0.015. Persisting epithelial defects occurred in 5 patients (50%) of group 1 and in 10 patients (77%) of group 2. In 5 eyes (group 2), no epithelial healing could be achieved. After 36 months, graft survival (Kaplan–Meier) was 78% (18 grafts) for all patients (90% in group 1 and 44% in group 2).

Conclusion

PKP 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.

Funding

We thank the Alexander von Humboldt Foundation for supporting the work of Prof. N. Szentmáry 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 Fees. The funding organisation had no role in the design or conduct of this research.

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Acknowledgements

Funding

We thank the Alexander von Humboldt Foundation for supporting the work of Prof. N. Szentmáry 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 Fees. The funding organisation had no role in the design or conduct of this research.

Medical Writing Assistance

Language editing and assistance for this article was provided by Chrisitna Turner of the ACT-Fachübersetzunge and was funded by the University of Saarland.

Authorship

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Disclosures

Kornélia L. Laurik, Nóra Szentmáry, Loay Daas, Achim Langenbucher and Berthold Seitz have nothing to disclose.

Compliance with Ethics Guidelines

All procedures performed in our study involving human participants were in accordance with the ethical standards of the Ethical Committee of the Medical Association of Saarland and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent for participation and publication of patient data was obtained from all individual participants included in the study.

Data Availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

We hereby thank all the participants of the study.

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Authors and Affiliations

  1. Department of Ophthalmology, Saarland University Medical Center, UKS, Homburg/Saar, Germany

    Kornélia L. Laurik, Nóra Szentmáry, Loay Daas & Berthold Seitz

  2. Department of Ophthalmology, Semmelweis University, Budapest, Hungary

    Nóra Szentmáry

  3. Institute of Experimental Ophthalmology, Saarland University, Homburg/Saar, Germany

    Achim Langenbucher

Authors
  1. Kornélia L. Laurik
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  2. Nóra Szentmáry
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  3. Loay Daas
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  4. Achim Langenbucher
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  5. Berthold Seitz
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Correspondence to Kornélia L. Laurik.

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Laurik, K.L., Szentmáry, N., Daas, L. et al. Early Penetrating Keratoplasty À Chaud May Improve Outcome in Therapy-Resistant Acanthamoeba Keratitis. Adv Ther 36, 2528–2540 (2019). https://doi.org/10.1007/s12325-019-01031-3

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  • DOI: https://doi.org/10.1007/s12325-019-01031-3

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