Acanthamoeba Keratitis in a Tertiary Referral Hospital in Central China: Demographics, Risk Factors, Clinical Presentation, Treatments and Outcomes

Abstract Purpose: To investigate the demographics, risk factors, clinical presentation, treatments and outcomes of Acanthamoeba keratitis (AK) in a tertiary referral hospital in central China. Methods: In this noncomparative, retrospective study, patients diagnosed with AK at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei province from April 2020 to March 2022 were included. Results: A total of 21 AK patients were enrolled between April 2020 and March 2022 at a tertiary referral hospital in central China. The most common potential predisposing factors were contact lens wearing (71.4%), mostly were students, and organic trauma (23.8%), mainly by outdoor workers. And 80.9% of patients were initially misdiagnosed with herpes keratitis. The clinical features were radial keratoneuritis 42.8% (n = 9), crude salt-like granular dense infiltration 28.6% (n = 6), and corneal ring infiltration28.6% (n = 6). Fifteen patients were completely cured by medical therapy, and six patients with corneal ring infiltration feature were performed conjunctival flap covering surgery (CFCS), three of them later underwent secondary deep anterior lamellar keratoplasty (DALK). All patients completed their follow-up at the Union Hospital, with a total of 20 patients (95.2%) had improved visual acuity after treatment, 1 had no change. Corneal scarring and vascularization were the two most common complications of AK in this study, with incidence rates of 85.7% and 28.6%, respectively. Conclusions: In central China, AK occurred predominantly in contact lens wearers, mainly in students with myopia prevention and control, sufficient attention should be paid to this population, and whom surprisingly without severe ocular pain. We also have found that the timely diagnosis and initiation of standardized antiamoebic therapies improves visual outcomes, decreases the duration of treatment, and reduces the chances of needing surgical intervention. Clinical feature radial keratoneuritis and crude salt-like granular dense infiltration are largely treatable with medications, whereas corneal ring infiltration requires prompt surgical intervention, and have a higher risk of corneal perforation, the two-step strategy (conjunctival flap covering surgery (CFCS) combined with secondary deep anterior lamellar keratoplasty (DALK)) is effective for patients with high-risk AK in this condition.