THE ROLE OF TOPICAL CORTICOSTEROIDS IN THE MANAGEMENT OF ACANTHAMOEBA-KERATITIS

Purpose. To clarify the role of topical corticosteroids in the managem ent of Acanthamoeba keratitis. Methods, The records of 38 patients dia gnosed with Acanthamoeba keratitis at three institutions were retrospe ctively reviewed. Results, After medical therapy alone, patients diagn osed within 1 month of symptom onset had an increased likelihood of be ing cured (p = 0.02) and attaining visual acuity of 20/60 or better (p < 0.01). Fourteen (73.7%) of 19 patients treated with topical cortico steroids at any time were cured after antiamoebal therapy alone, where as five (26.3%) patients required penetrating keratoplasty for either persistent infection (n = 3) or perforation (n = 2). The mean antiamoe bal therapy duration, excluding duration after keratoplasty if applica ble, was 38.5 weeks. Thirteen (76.5%) of 17 patients treated with anti amoebal therapy without topical corticosteroids were medically cured, whereas four (23.5%) required penetrating keratoplasty for either pers istent infection (n = 2) or perforation(n = 2). The mean antiamoebal t herapy duration was 20 weeks. Although the mean antiamoebal therapy du ration in the steroid-treated group was significantly longer than that in the non-steroid-treated group (p = 0.02), outcome after medical th erapy between the groups was not significantly different. Conclusions. Topical corticosteroids were not associated with a higher rate of med ical treatment failure in patients with Acanthamoeba keratitis. Rather , poor outcome was significantly related to diagnostic delays. Therefo re prudent use of corticosteroids in selected patients with severe pai n not responsive to analgesics or severe corneal or anterior chamber i nflammation appears justified.