Therapeutic and Optical Keratoplasty in the Management of Acanthamoeba Keratitis
| Autor: | Dana Robaei, Darwin C Minassian, John Dart, Nicole Carnt |
|---|---|
| Rok vydání: | 2015 |
| Předmět: |
medicine.medical_specialty
Visual acuity genetic structures medicine.diagnostic_test business.industry Medical record Physical examination Retrospective cohort study Corneal perforation medicine.disease eye diseases Keratitis Surgery Ophthalmology Acanthamoeba keratitis medicine Fungal keratitis medicine.symptom business |
| Zdroj: | Ophthalmology. 122:17-24 |
| ISSN: | 0161-6420 |
| DOI: | 10.1016/j.ophtha.2014.07.052 |
| Popis: | Objective To report the risk factors for and outcomes of therapeutic and optical keratoplasty in the management of Acanthamoeba keratitis (AK). Design Retrospective case series. Participants A total of 50 eyes of 196 patients with retrievable medical records, diagnosed with AK at Moorfields Eye Hospital, London, underwent keratoplasty between January 1991 and April 2012. Methods Patient demographics, initial clinical examination findings, and management details were collected. The ophthalmic characteristics of patients who underwent keratoplasty for AK were compared with those who did not. Patients undergoing therapeutic keratoplasty were compared with those undergoing optical keratoplasty for baseline characteristics, management details, and visual outcomes. A multivariate logistic model was used to derive the odds ratios of a poor visual outcome in all keratoplasty patients. Main Outcome Measures Poor visual outcome was defined as final visual acuity of 20/200 or worse. Secondary outcomes of interest included number of clinic visits and the need for additional intraocular surgery. Results Of the 196 AK patients, a total of 50 patients (25.5%) underwent penetrating or anterior lamellar keratoplasty, 10 of whom (20%) underwent repeat procedures. Of these 50 patients, 26 (52%) had therapeutic keratoplasty, predominantly for corneal perforation. The remaining 24 patients (48%) underwent optical keratoplasty for visual rehabilitation. Thirty-seven (80.4%) patients in the keratoplasty group initially were misdiagnosed as having herpes simplex keratitis versus 59 (41.8%) patients who did not require a keratoplasty ( P Conclusions The prognosis of keratoplasty differs markedly when performed for therapeutic purposes compared with visual rehabilitation. Where possible, keratoplasty should be delayed until such time as the eye is uninflamed and medically cured of Acanthamoeba . |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|