The rising incidence of Acanthamoeba keratitis: A 7-year nationwide survey and clinical assessment of risk factors and functional outcomes

Anna C. Randag*, Jeroen van Rooij, Arnoud T. van Goor, Samuel Verkerk, Robert P. L. Wisse, Isabelle E. Y. Saelens, Remco Stoutenbeek, Bart T. H. van Dooren, Yanny Y. Y. Cheng, Cathrien A. Eggink

*Corresponding author for this work

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    Abstract

    Purpose

    To evaluate the incidence of Acanthamoeba keratitis in the Netherlands between 2009 and 2015 and to analyse predicting factors for treatment outcome.

    Methods

    Patient characteristics, diagnostic methods, diagnostic delay, therapy prior to and after diagnosis, and visual outcome were obtained from medical files of all patients diagnosed with Acanthamoeba keratitis in the Netherlands between 2009 and 2015. A logistic regression analysis on treatment failure, defined as a best corrected visual acuity of less than 20/40 Snellen decimals (i.e. > 0.3 logMAR or an approximate loss of three lines of visual acuity) and/or the need for keratoplasty, was performed to determine predicting factors.

    Results

    Two hundred and twenty-four eyes of 224 patients were included. Ninety-five percent of the patients were contact lens wearers, of whom 74% wore soft contact lenses. The number of cases increased from 16 in 2009 to 49 in 2015. This resulted in an estimated incidence of 1 in 21,000 for soft contact lens wearers in 2015. Eighty-seven eyes (39%) met the criteria for treatment failure. In a multivariable regression analysis, higher age at presentation, a higher severity stage and corticosteroid use before diagnosis were positively correlated with treatment failure. Early referral to a cornea specialist was associated with better clinical outcomes.

    Conclusions

    Although Acanthamoeba keratitis is still a relatively uncommon disease, the incidence in soft contact lens wearers has increased to reach 1 in 21,000 in 2015. Treatment failure occurred in 39% of cases, with age, higher severity stage, corticosteroid use before diagnosis and indirect referral to a cornea specialist as important risks factors.

    Original languageEnglish
    Article number0222092
    Number of pages12
    JournalPLoS ONE
    Volume14
    Issue number9
    DOIs
    Publication statusPublished - 6-Sept-2019

    Keywords

    • DIAGNOSIS
    • EPIDEMIOLOGY
    • ENGLAND

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