Department of Ophthalmology, Saarland University Medical Center, UKS, Homburg/Saar, Germany.
Department of Ophthalmology, Semmelweis University, Budapest, Hungary.
Adv Ther. 2019 Sep;36(9):2528-2540. doi: 10.1007/s12325-019-01031-3. Epub 2019 Jul 17.
Long-standing acanthamoeba keratitis (AK) may result in corneal neovascularization, extension of the infiltrate to the limbus or sclera, broad peripheral synechiae, mature cataract or ischemic posterior segment inflammation. We investigated the impact of early emergency penetrating keratoplasty (PKP) in therapy-resistant cases among the patients of a highly specialized tertiary care center.
In this retrospective, observational cohort within a single institution, we collected data on best-corrected visual acuity (BCVA), epithelial wound healing, graft survival and secondary complications of AK patients who underwent PKP. A total of 23 eyes of 23 patients diagnosed with acute, therapy-resistant AK between 2006 and 2015 were enrolled. Postoperative combined topical treatment was tapered for 6-9 months.
Eyes were grouped based on preoperative disease duration as shorter (group 1) or longer (group 2) than the median. The median was 5.3 (0.66-36) months. The BCVA in group 1 (20/44 ± 20/18; 0.32 ± 0.18 logMAR) was significantly better than in group 2 (20/1200 ± 20/1133; 1.28 ± 0.89; logMAR); p = 0.015. Persisting epithelial defects occurred in 5 patients (50%) of group 1 and in 10 patients (77%) of group 2. In 5 eyes (group 2), no epithelial healing could be achieved. After 36 months, graft survival (Kaplan-Meier) was 78% (18 grafts) for all patients (90% in group 1 and 44% in group 2).
PKP à chaud within 5.3 months after first symptoms of therapy-resistant AK seems to result in better final BCVA than delayed graft surgery if the disease is resistant to a classical topical triple therapy. In addition, early PKP may have a favorable impact on epithelial healing and graft survival.
We thank the Alexander von Humboldt Foundation for supporting the work of Prof. N. Szentmáry at the Department of Ophthalmology of Saarland University Medical Center in Homburg/Saar, Germany. We thank the University of Saarland for funding the medical writing assistance and the Rapid Service Fees. The funding organisation had no role in the design or conduct of this research.
长期棘阿米巴角膜炎（AK）可能导致角膜新生血管形成、浸润延伸至角膜缘或巩膜、广泛的周边虹膜后粘连、成熟白内障或缺血性后节炎症。我们研究了在一家高度专业化的三级保健中心，对治疗抵抗病例进行早期紧急穿透性角膜移植术（PKP）的影响。
在这项单中心回顾性观察性队列研究中，我们收集了 2006 年至 2015 年间接受 PKP 的 AK 患者的最佳矫正视力（BCVA）、上皮伤口愈合、移植物存活率和继发性并发症的数据。共纳入 23 例 23 只眼，均诊断为急性、治疗抵抗性 AK。术后联合局部治疗持续 6-9 个月。
根据术前疾病持续时间将眼分为较短（第 1 组）或较长（第 2 组）。中位数为 5.3（0.66-36）个月。第 1 组（20/44 ± 20/18；0.32 ± 0.18 logMAR）的 BCVA 明显优于第 2 组（20/1200 ± 20/1133；1.28 ± 0.89；logMAR）；p=0.015。第 1 组中有 5 名患者（50%）和第 2 组中有 10 名患者（77%）持续存在上皮缺损。第 2 组中有 5 只眼（50%）无法实现上皮愈合。36 个月时，所有患者的移植物存活率（Kaplan-Meier）为 78%（18 个移植物）（第 1 组为 90%，第 2 组为 44%）。
如果疾病对经典的三联局部治疗有抗药性，那么在治疗抵抗性 AK 出现症状后 5.3 个月内进行早期 PKP 似乎比延迟移植物手术能获得更好的最终 BCVA。此外，早期 PKP 可能对上皮愈合和移植物存活率有积极影响。
我们感谢亚历山大·冯·洪堡基金会支持德国萨尔兰大学医学中心眼科的 Szentmáry 教授的工作。我们感谢萨尔兰大学为医学写作援助和快速服务费提供资金。该资助组织在设计或进行这项研究中没有发挥作用。
