Clinical outcomes and prognostic factors in Acanthamoeba keratitis

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To report clinical findings and prognostic factors for visual and morphological outcomes in patients with Acanthamoeba keratitis (AK). Single-center, retrospective, longitudinal study of 51 cases of AK diagnosed by real-time polymerase chain reaction (RT-PCR) between March 2010 and October 2022. The primary outcome was the final best corrected visual acuity (BCVA). Poor visual outcome was defined as a final BCVA≥1 logMAR unit, while good visual outcome was defined as a final BCVA<1 logMAR unit. Eyes from these two groups were compared, regarding demographic and initial clinical variables, anti-Acanthamoeba treatment used, and complications of the disease. Early diagnosis was defined as≤14days from symptom onset to diagnostic confirmation and initiation of Acanthamoeba medical treatment. Multivariable logistic regression was used to determine predictors of poor visual outcome. A total of 51 eyes from 46 patients diagnosed with AK, all contact lens (CL) wearers, were included in this study. Average follow-up was 39.0±30.2 [total range 14-120] months. Thirty-one eyes (60.8%) presented good visual outcome, with a lower baseline age (30.5±9.0 vs. 42.3±15.8; p=0.020), better initial BCVA (0.8±0.7 logMAR units vs. 1.3±0.9 logMAR units; p=0.047), higher rate of early diagnosis (45.2% vs. 5.6%; p=0.004), and higher rate of therapeutic epithelial debridement (64.5% vs. 10%; p<0.001). 20 eyes (39.2%) presented poor visual outcome, with 12 eyes undergoing evisceration/enucleation (23.5%). These 20 eyes presented a higher rate of complications (90% vs. 61.3%; p=0.031). In multivariable analysis, early diagnosis of AK (OR 19.78; 95% CI 2.07-189.11; p=0.010) and therapeutic epithelial debridement (OR 19.02; 95% CI 3.27-110.57; p=0.001) were associated with a good visual outcome. In the present study, poor visual outcome was present in 39% of affected eyes. Early AK diagnosis (≤14days from symptom onset) and therapeutic epithelial debridement were associated with good final visual outcome.