Acanthamoeba keratitis in a tertiary referral hospital in central China: demographics, risk factors, clinical presentation, treatments and outcomes

Abstract

• AIM: To investigate the demographics, risk factors, clinical presentation, treatments and outcomes of Acanthamoeba keratitis (AK) in a tertiary referral hospital in central China. • METHODS: In this noncomparative, retrospective study, a total of 21 AK patients were enrolled between April 2020 and March 2023. All patients underwent anterior segment photography, in vivo confocal microscopy (IVCM), best-corrected visual acuity (BCVA) and anterior segment optical coherence tomography (AS-OCT). • RESULTS: The most common potential predisposing factors were contact lens wearing (71.4%), mostly were students, and organic trauma (23.8%), mainly by outdoor workers. And 80.9% of patients were initially misdiagnosed with herpes keratitis. The clinical features were radial keratoneuritis 42.8% (n=9), crude salt-like granular dense infiltration 28.6% (n=6), and corneal ring infiltration 28.6% (n=6). Fifteen patients were completely cured by medical therapy, and six patients with corneal ring infiltration feature were performed conjunctival flap covering surgery (CFCS), three of them later underwent secondary deep anterior lamellar keratoplasty (DALK). All patients completed their follow-up at the Union Hospital, with a total of 20 patients (95.2%) had improved visual acuity after treatment, 1 had no change. Corneal scarring and vascularization were the two most common complications of AK in this study, with incidence rates of 85.7% and 28.6%, respectively. • CONCLUSION: In central China, AK occurs predominantly in contact lens wearers, mainly in students with myopia prevention and control. The radial keratoneuritis with crude salt-like granular dense infiltration can generally be effectively managed with medications. In contrast, corneal ring infiltration necessitates immediate surgical intervention. The CFCS combined with secondary DALK is effective for patients with high-risk AK in this condition.