Acanthamoeba Keratitis Management and Prognostic Factors: a systematic review

Abstract

Background/Objectives: To review therapeutic and prognostic factors influencing Acanthamoeba Keratitis (AK) management. Methods: A systematic search was performed across MEDLINE (via PubMed), Web of Science, and Scopus, following PRISMA guidelines. Studies reporting AK treatment regimens and prognostic factors were included. After extracting the data from the included articles, relevant aspects of treatment and prognostic factors were compared and summarized. Results: Sixty-one articles were included: nine were prospective, including 3 randomized controlled trials (RCTs), and fifty-two were retrospective. Findings suggest that therapeutic epithelial debridement (TED) followed by an association with biguanides, diamidines, and an antibacterial agent is a strong initial treatment option. Adjunctive medical treatment with topical voriconazole 1% or oral miltefosine may also be considered. Surgical approaches were also assessed when medical therapy failed, with Deep Anterior Lamellar Keratoplasty (DALK) playing an important role in cases without deep stroma involvement. Therapeutic Penetrating Keratoplasty (TPK) should be used as salvage therapy and Optical Penetrating Keratoplasty (OPK) for rehabilitation purposes. Key prognostic factors include older age, delayed diagnosis, corticosteroid use before prompt diagnosis, poor initial best corrected visual acuity (BCVA), and AK stage at presentation. Conclusions: Initial treatment with TED, biguanides, and diamidines, remains the foundation of treatment. Surgical options can be considered in advanced cases. Early diagnosis, age, and initial BCVA are prognosis factors that should be considered. Future research may focus on improvement of protocols and searching for novel therapeutical agents.