Diagnosis and treatment of Acanthamoeba Keratitis: A scoping review demonstrating unfavorable outcomes

Büchele, Maria Luiza Carneiro; Nunes, Bruno Fonseca; Filippin-Monteiro, Fabíola Branco; Caumo, Karin Silva

doi:10.1016/j.clae.2023.101844

Cited by 6 publications

(4 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Across all treatment arms with ≥5 treated eyes, the weighted mean of the percentage cured was 60.1% (range: 4% to 100%). This accords with a recent scoping review which also found that the AK continues to be associated with unfavourable outcomes 6 . Subgroup analyses suggested that the percentage was lower in good quality (57.6%) than fair or poor quality (66.0%) studies.…”

Section: Clinical Findingssupporting

confidence: 82%

“…There are currently no approved medicinal products or clinical guidelines for treating AK 6 . Current management approaches typically use combination therapy of biguanides (polihexanide or chlorhexidine) and diamidines (propamidine or hexamidine) [1][2][3][4]6 . Polihexanide (PHMB) and chlorhexidine are generally administered at a concentration of 0.02% (or 0.2 mg/ml).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Current Clinical Evidence for Agents used in Acanthamoeba Keratitis: Systematic Literature Reviews

H. Bodicoat,

Papa,

Alves

et al. 2023

J Rare Dis Res Treat

View full text Add to dashboard Cite

To describe the evidence for agents with anti-amoebic activity used to treat Acanthamoeba keratitis (AK), two systematic literature reviews (SLRs) were conducted of 1) clinical outcomes for patients with AK and 2) health economic outcomes for patients with AK or microbial keratitis (MK). The intervention of interest was any agent with anti-amoebic activity administered as eye-drops or orally. The main outcome was clinical resolution. Electronic databases (January 1992-July 2022), conference abstracts (2017-2022), and relevant websites were hand-searched. Risk of bias assessments used external assessment tools. A narrative synthesis was conducted. The clinical SLR (37 studies; 2043 patients) identified at least 20 studies reporting clinical resolution, best-corrected visual acuity, and corneal surgery; fewer studies reported other outcomes. Treatment regimes, outcome definitions and assessment timing varied markedly between studies. Studies classified as fair or poor quality appeared to underestimate the burden of AK compared with good quality studies. For health economic outcomes (15 studies; 1878 patients), very limited evidence in AK populations was found. In conclusion, there was a substantial amount of clinical evidence, but scarce economic evidence. Study quality and comparability challenges should be considered when estimating the impact of AK, with substantial between-study heterogeneity limiting options for robust evidence synthesis.

show abstract

Section: Clinical Findingssupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Current Clinical Evidence for Agents used in Acanthamoeba Keratitis: Systematic Literature Reviews

H. Bodicoat,

Papa,

Alves

et al. 2023

J Rare Dis Res Treat

View full text Add to dashboard Cite

show abstract

“…Typical treatment for Acanthamoeba keratitis (AK) often involves the topical application of biguanides (eg, chlorhexidine, PHMB) and diamidines (such as propamidine isethionate, hexamidine) administered hourly. 112 However, prolonged use of chlorhexidine and PHMB can result in adverse effects like corneal ulceration and photophobia. 113 Systemic miltefosine 114 or antifungals (like neomycin, itraconazole, clotrimazole, and voriconazole) 115 , 116 may be used adjunctively to topical treatment.…”

Section: Characteristics and Treatment Of Infectious Keratitis In The...mentioning

confidence: 99%

Infectious Keratitis in Patients Over 65: A Review on Treatment and Preserving Eyesight

Kim,

Karslioglu,

Zhao

et al. 2024

CIA

View full text Add to dashboard Cite

Infectious keratitis (IK) represents a significant global health concern, ranking as the fifth leading cause of blindness worldwide despite being largely preventable and treatable. Elderly populations are particularly susceptible due to age-related changes in immune response and corneal structure. However, research on IK in this demographic remains scarce. Age-related alterations such as increased permeability and reduced endothelial cell density further compound susceptibility to infection and hinder healing mechanisms. Additionally, inflammaging, characterized by chronic inflammation that develops with advanced age, disrupts the ocular immune balance, potentially exacerbating IK and other age-related eye diseases. Understanding these mechanisms is paramount for enhancing IK management, especially in elderly patients. This review comprehensively assesses risk factors, clinical characteristics, and management strategies for bacterial, viral, fungal, and acanthamoeba keratitis in the elderly population, offering crucial insights for effective intervention.

show abstract

“…This previous SLR also only included randomized controlled trials (RCTs), of which only one eligible RCT comparing two treatments was identified 7 . Additionally, a scoping review has recently been published, which identified that agents with anti-amoebic activity are typically only prescribed for patients with AK after other treatments have been exhausted 6 . No evidence syntheses using meta-analysis or indirect treatment comparisons were identified.…”

Section: Search Strategiesmentioning

confidence: 99%

Untitled

2023

J Rare Dis Res Treat

View full text Add to dashboard Cite

To describe the evidence for agents with anti-amoebic activity used to treat Acanthamoeba keratitis (AK), two systematic literature reviews (SLRs) were conducted of 1) clinical outcomes for patients with AK and 2) health economic outcomes for patients with AK or microbial keratitis (MK).The intervention of interest was any agent with anti-amoebic activity administered as eye-drops or orally. The main outcome was clinical resolution. Electronic databases (January 1992-July 2022), conference abstracts (2017-2022), and relevant websites were hand-searched. Risk of bias assessments used external assessment tools. A narrative synthesis was conducted.The clinical SLR (37 studies; 2043 patients) identified at least 20 studies reporting clinical resolution, best-corrected visual acuity, and corneal surgery; fewer studies reported other outcomes. Treatment regimes, outcome definitions and assessment timing varied markedly between studies. Studies classified as fair or poor quality appeared to underestimate the burden of AK compared with good quality studies. For health economic outcomes (15 studies; 1878 patients), very limited evidence in AK populations was found.In conclusion, there was a substantial amount of clinical evidence, but scarce economic evidence. Study quality and comparability challenges should be considered when estimating the impact of AK, with substantial betweenstudy heterogeneity limiting options for robust evidence synthesis.

show abstract

Diagnosis and treatment of Acanthamoeba Keratitis: A scoping review demonstrating unfavorable outcomes

Cited by 6 publications

References 47 publications

Current Clinical Evidence for Agents used in Acanthamoeba Keratitis: Systematic Literature Reviews

Current Clinical Evidence for Agents used in Acanthamoeba Keratitis: Systematic Literature Reviews

Infectious Keratitis in Patients Over 65: A Review on Treatment and Preserving Eyesight

Untitled

Contact Info

Product

Resources

About