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Therapeutic keratoplasty for severe Acanthamoeba keratitis: risk factors, clinical features, and outcomes of postoperative recurrence

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Abstract

Purpose

To investigate the effect of therapeutic keratoplasty (TKP) in patients with severe Acanthamoeba keratitis (AK) and to analyse the clinical features and risk factors for recurrence.

Methods

Clinical data of patients with severe AK treated with lamellar keratoplasty (LK) or penetrating keratoplasty (PK) due to ineffective drug therapy were analysed in this retrospective study. The effects of keratoplasty, clinical features, and risk factors for recurrence were analysed.

Results

The cohort comprised of 58 patients (59 eyes). Of these, 36 eyes were treated with PK and 23 were treated with LK. The probabilities of successful globe salvage were 91.7% and 91.3%, respectively. The final visual acuity (VA) was ≥ 20/60 in 14 eyes (38.9%) that underwent PK and 15 eyes (65.2%) that underwent LK. Postoperative recurrence of Acanthamoeba infection was detected in 10 eyes; 6 eyes (16.7%) showed recurrence after PK, and 4 eyes (17.4%) showed recurrence after LK. Recurrence occurred between 3 and 80 days (median, 14.5 days) after the operation. The risk factors for recurrence after LK were topical corticosteroid use before diagnosis (p = 0.040) and hypopyon (p = 0.009), while those after PK were topical corticosteroid use before diagnosis (p = 0.045). Clinical manifestations of postoperative recurrence include greyish-white infiltration of the recipient bed, anterior chamber inflammation, graft oedema, and keratic precipitate.

Conclusion

TKP is a treatment option for severe AK that responds poorly to antiamoebic therapy (AAT), although Acanthamoeba infection may relapse, and the visual prognosis is guarded. Topical corticosteroid use before AAT and hypopyon is the two risk factors for recurrence.

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Funding

This study was partially supported by the Academic Promotion Program and Innovation Project of Shandong First Medical University (2019ZL001 and 2019RC008).

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Authors and Affiliations

  1. Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China

    Ting Zhang, Lixin Xie, Yanling Dong & Jun Cheng

  2. State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute of Shandong First Medical University, Qingdao, China

    Ting Zhang, Lixin Xie, Yanling Dong & Jun Cheng

Authors
  1. Ting Zhang
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  2. Lixin Xie
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  3. Yanling Dong
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  4. Jun Cheng
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Contributions

All authors contributed to study conception and design. Jun Cheng designed the review protocol, wrote the protocol, conducted the search, and screened the potentially eligible studies. Ting Zhang was responsible for writing the report, extracting and analysing data, conducting the statistical analyses, interpreting results, updating reference lists, and creating tables. Lixin Xie and Yanling Dong contributed to data extraction and provided feedback regarding the report. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Jun Cheng.

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Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Ethics Committee of Qingdao Eye Hospital affiliated to Shandong first Medical University) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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The authors declare no competing interests.

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Zhang, T., Xie, L., Dong, Y. et al. Therapeutic keratoplasty for severe Acanthamoeba keratitis: risk factors, clinical features, and outcomes of postoperative recurrence. Graefes Arch Clin Exp Ophthalmol 261, 1299–1309 (2023). https://doi.org/10.1007/s00417-022-05883-4

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  • DOI: https://doi.org/10.1007/s00417-022-05883-4

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