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The Role of Topical Corticosteroids in the Management of Acanthamoeba Keratitis.

Park, David H. M.D.; Palay, David A. M.D.; Daya, Sheraz M. M.D.; Stulting, R. Doyle M.D.; Krachmer, Jay H. M.D.; Holland, Edward J. M.D.

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Abstract

Purpose: To clarify the role of topical corticosteroids in the management of Acanthamoeba keratitis.

Methods: The records of 38 patients diagnosed with Acanthamoeba keratitis at three institutions were retrospectively reviewed.

Results: After medical therapy alone, patients diagnosed within 1 month of symptom onset had an increased likelihood of being cured (p = 0.02) and attaining visual acuity of 20/60 or better (p < 0.01). Fourteen (73.7%) of 19 patients treated with topical corticosteroids at any time were cured after antiamoebal therapy alone, whereas five (26.3%) patients required penetrating keratoplasty for either persistent infection (n = 3) or perforation (n = 2). The mean antiamoebal therapy duration, excluding duration after keratoplasty if applicable, was 38.5 weeks. Thirteen (76.5%) of 17 patients treated with antiamoebal therapy without topical corticosteroids were medically cured, whereas four (23.5%) required penetrating keratoplasty for either persistent infection (n = 2) or perforation (n = 2). The mean antiamoebal therapy duration was 20 weeks. Although the mean antiamoebal therapy duration in the steroid-treated group was significantly longer than that in the non-steroid-treated group (p = 0.02), outcome after medical therapy between the groups was not significantly different.

Conclusions: Topical corticosteroids were not associated with a higher rate of medical treatment failure in patients with Acanthamoeba keratitis. Rather, poor outcome was significantly related to diagnostic delays. Therefore prudent use of corticosteroids in selected patients with severe pain not responsive to analgesics or severe corneal or anterior chamber inflammation appears justified.

(C) Lippincott-Raven Publishers.

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