Oral Miltefosine as Salvage Therapy for Refractory Acanthamoeba Keratitis

Thulasi, Praneetha; Saeed, Hajirah N.; Rapuano, Christopher J.; Hou, Joshua H.; Appenheimer, A. Ben; Chodosh, James; Kang, Joann J.; Morrill, Amber M.; Vyas, Neil; Zegans, Michael E.; Zuckerman, Richard A.; Tu, Elmer Y.

doi:10.1016/j.ajo.2020.09.048

Cited by 22 publications

(20 citation statements)

References 39 publications

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“…Miltefosine is a recently approved option for treatment-resistant AK with activity against both the trophozoite and cystic forms, which has shown promise in otherwise refractory cases [ 11 ]. Notably, it was originally developed in the 1980s as an antineoplastic agent; however, levels required to be sufficiently antineoplastic would be nearly universally lethal [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Acanthamoeba Keratitis: A Single-Institution Series of Four Cases With Literature Review

Smith¹,

Ashraf²,

Haghnegahdar³

et al. 2022

Cureus

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Acanthamoeba species are free-living protozoa found pervasively in water and soil, which can cause infections of the central nervous system, skin, and eye. Amoebic keratitis (AK) is a vision-threatening, often chronic infection that is associated with the use of soft contact lenses due to corneal microtrauma and improper cleaning and storage. Although AK infections are rare, they cause significant morbidity including vision loss due to the diagnostic and therapeutic challenges they pose.The clinical course is determined by the organism's inherent pathogenicity, delay of diagnosis, and the paucity of data on effective therapeutic regimens. The case series and review of literature that follows examine current latest best practices in AK diagnosis including in vivo confocal microscopy (IVCM) and therapeutic interventions including miltefosine.

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Section: Discussionmentioning

confidence: 99%

Acanthamoeba Keratitis: A Single-Institution Series of Four Cases With Literature Review

Smith¹,

Ashraf²,

Haghnegahdar³

et al. 2022

Cureus

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“…Miltefosine is an alkylphosphocholine drug approved by the FDA in 2016 as an orphan drug for treatment of Acanthamoeba keratitis. Documented treatment success has been limited to primarily case reports and small series [68,69]. The main side effects noted were nausea and vomiting, and elevated liver enzymes [69].…”

Section: Therapy For Acanthamoeba Keratitismentioning

confidence: 99%

“…Documented treatment success has been limited to primarily case reports and small series [68,69]. The main side effects noted were nausea and vomiting, and elevated liver enzymes [69]. Several clinicians have reported increased corneal inflammation leading to corneal and scleral melts after initiating miltefosine that required topical and/or oral steroids [69][70][71].…”

Section: Therapy For Acanthamoeba Keratitismentioning

confidence: 99%

Therapy for contact lens-related ulcers

Jeang

Tuli

2022

Current Opinion in Ophthalmology

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Purpose of reviewThe current review covers the current literature and practice patterns of antimicrobial therapy for contact lens-related microbial keratitis (CLMK). Although the majority of corneal ulcers are bacterial, fungus and acanthamoeba are substantial contributors in CLMK and are harder to treat due to the lack of commercially available topical medications and low efficacy of available topical therapy.Recent findingsTopical antimicrobials remain the mainstay of therapy for corneal ulcers. Fluoroquinolones may be used as monotherapy for small, peripheral bacterial ulcers. Antibiotic resistance is a persistent problem. Fungal ulcers are less responsive to topical medications and adjunct oral or intrastromal antifungal medications may be helpful. Acanthamoeba keratitis continues to remain a therapeutic challenge but newer antifungal and antiparasitic agents may be helpful adjuncts. Other novel and innovative therapies are being studied currently and show promise.SummaryContact lens-associated microbial keratitis is a significant health issue that can cause vision loss. Treatment remains a challenge but many promising diagnostics and procedures are in the pipeline and offer hope.

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“…A few case series have shown success for refractory AK; however, there appears to be a high rate of initially worsened inflammation. 25 Topical or oral steroids The use of topical steroids is controversial in AK. Although it is commonly accepted that the use of topical steroids before the diagnosis and treatment of AK is associated with worse outcomes (due to increased trophozoite expression), 26,27 there may be a role for delayed topical steroids as an adjunct therapy to control inflammation.…”

Section: Phmb and Chlorhexidine Have Been Shown To Have Relatively Lo...mentioning

confidence: 99%

An Update on Advances in Diagnosis and Treatment of Acanthamoeba Keratitis

Tian¹,

Peralta²,

Houser³

2022

US Ophthalmic Review

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Acanthamoeba keratitis (AK) is a potentially devastating infection of the ocular surface caused by amoebas of the genus Acanthamoeba. Although the organism is classically known for being difficult to detect and treat, recent advances in the field have greatly improved diagnostic accuracy and treatment efficacy. In this update, we review the current body of knowledge about AK epidemiology and pathogenesis, discuss the advances in diagnosis with confocal microscopy and polymerase chain reaction, and explore potential novel treatments such as voriconazole, miltefosine, topical steroids, phototherapeutic keratectomy, cross-linking and photodynamic therapy.

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Oral Miltefosine as Salvage Therapy for Refractory Acanthamoeba Keratitis

Cited by 22 publications

References 39 publications

Acanthamoeba Keratitis: A Single-Institution Series of Four Cases With Literature Review

Acanthamoeba Keratitis: A Single-Institution Series of Four Cases With Literature Review

Therapy for contact lens-related ulcers

An Update on Advances in Diagnosis and Treatment of Acanthamoeba Keratitis

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