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Practice patterns and opinions in the treatment of acanthamoeba keratitis.

AbstractPURPOSE:
Management of acanthamoeba keratitis remains challenging for ophthalmologists. We conducted a survey of members of The Cornea Society to elicit expert opinions on the diagnosis and treatment of acanthamoeba keratitis.
METHODS:
An online survey was sent to all subscribers of The Cornea Society via the kera-net listserv. Descriptive statistics were performed.
RESULTS:
Eighty-two participants completed the online survey. Of the 82 respondents, 76.8% included the combination of clinical examination and culture in their diagnostic strategy and 43.9% used confocal microscopy. Most respondents (97.6%) had used combination therapy with multiple agents to treat acanthamoeba keratitis at some point in the past, whereas a smaller proportion (47.6%) had ever used monotherapy. Respondents most commonly chose polyhexamethylene biguanide as the ideal choice for monotherapy (51.4%), and dual therapy with a biguanide and diamidine as the ideal choice for combination therapy (37.5%). The majority of respondents (62.2%) reported using topical corticosteroids at least some of the time for acanthamoeba keratitis. Keratoplasty was an option considered by most respondents (75.6%), although most (85.5%) would only perform surgery after medical treatment failure.
CONCLUSIONS:
There was a wide range of current practice patterns for the diagnosis and treatment of acanthamoeba keratitis. The lack of sufficiently powered comparative effectiveness studies and clinical trials makes evidence-based decision-making for this disease difficult.
AuthorsCatherine E Oldenburg, Nisha R Acharya, Elmer Y Tu, Michael E Zegans, Mark J Mannis, Bruce D Gaynor, John P Whitcher, Thomas M Lietman, Jeremy D Keenan
JournalCornea (Cornea) Vol. 30 Issue 12 Pg. 1363-8 (Dec 2011) ISSN: 1536-4798 [Electronic] United States
PMID21993459 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
Chemical References
  • Adrenal Cortex Hormones
  • Anti-Bacterial Agents
  • Antiprotozoal Agents
  • Biguanides
Topics
  • Acanthamoeba Keratitis (diagnosis, therapy)
  • Adrenal Cortex Hormones (therapeutic use)
  • Anti-Bacterial Agents (therapeutic use)
  • Antiprotozoal Agents (therapeutic use)
  • Biguanides (therapeutic use)
  • Drug Therapy, Combination
  • Humans
  • Keratoplasty, Penetrating
  • Male
  • Microscopy, Confocal
  • Ophthalmology
  • Practice Patterns, Physicians'
  • Surveys and Questionnaires

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