Successful Treatment of Chronic Stromal Acanthamoeba Keratitis With Oral Voriconazole Monotherapy
- 1 September 2010
- journal article
- case report
- Published by Ovid Technologies (Wolters Kluwer Health) in Cornea
- Vol. 29 (9), 1066-1068
- https://doi.org/10.1097/ico.0b013e3181cbfa2c
Abstract
Purpose: To describe the treatment of chronic stromal Acanthamoeba keratitis (AK) with oral voriconazole monotherapy. Methods: All cases of chronic stromal AK recalcitrant to traditional therapy subsequently treated with systemic voriconazole seen at the University of Illinois Eye and Ear Infirmary between June 2003 and July 2009 were reviewed for clinical presentation, clinical course, and outcome. Results: Three eyes of 2 patients were identified with culture-confirmed chronic stromal AK unresponsive to traditional antiacanthamoebal therapies, requiring topical corticosteroids to maintain corneal clarity. Oral voriconazole 200 mg twice daily achieved a rapid but transient reduction of inflammation and elimination of corticosteroid dependency but, in both patients, recrudesced approximately 6 weeks after its discontinuation. Subsequent repeated and/or extended use of oral voriconazole alone resulted in complete resolution ranging from 7 to 11 months off all medications with final best-corrected visual acuity ranging from 20/20 to 20/25. Conclusions: Recalcitrant chronic Acanthamoeba stromal keratitis was successfully treated with extended systemic voriconazole administration with good preservation of vision. The clinical resolution of chronic stromal keratitis in our 2 cases suggests that voriconazole may have a larger role in the treatment of AK.Keywords
This publication has 15 references indexed in Scilit:
- Comparison of Polyhexamethylene Biguanide and Chlorhexidine as Monotherapy Agents in the Treatment of Acanthamoeba KeratitisAmerican Journal of Ophthalmology, 2008
- A case of successful treatment of cutaneous Acanthamoeba infection in a lung transplant recipientTransplant Infectious Disease, 2007
- [Acanthamoeba keratitis: about the first two Tunisian cases].2007
- Use of Higher Medication Concentrations in the Treatment of Acanthamoeba KeratitisAmerican Journal of Ophthalmology, 2006
- In‐Vitro Activity of Miltefosine and Voriconazole on Clinical Isolates of Free‐Living Amebas: Balamuthia mandrillaris, Acanthamoeba spp., and Naegleria fowleriThe Journal of Eukaryotic Microbiology, 2006
- Persistence of acanthamoeba antigen following acanthamoeba keratitisBritish Journal of Ophthalmology, 2001
- Oral Itraconazole and Topical Miconazole With Debridement for Acanthamoeba KeratitisAmerican Journal of Ophthalmology, 1990
- Acanthamoeba KeratitisAmerican Journal of Ophthalmology, 1988
- Acanthamoeba Keratitis Associated With Soft Contact LensesAmerican Journal of Ophthalmology, 1985
- Management of Acanthamoeba KeratitisOphthalmology, 1984