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Systemic Miltefosine as an Adjunct Treatment of Progressive Acanthamoeba Keratitis.

Abstract
Purpose: To report our experience with oral miltefosine (MLT) as an adjunct treatment for progressive Acanthamoeba keratitis (AK).Methods: Retrospective case series of all patients who underwent treatment with oral MLT for AK at Bascom Palmer Eye Institute from 2017 to 2020.Results: Six females from 16 to 55 years old, with a microbiologic diagnosis of Acanthamoeba, were treated with MLT and standard medical treatment. Four of the six cases deteriorated after initiating treatment and three required a therapeutic keratoplasty. Two patients improved after 1 week of MLT and optical penetrating keratoplasty was performed after clinical resolution. Microbiologic culture of corneal buttons was negative in all cases. All corneal grafts remain clear at last follow-up with best-corrected visual acuity of 20/40 or better.Conclusion: Oral MLT may be a viable adjunctive therapy for recalcitrant AK; however, its use may be associated with a severe inflammatory reaction. Further studies are needed to evaluate its efficacy and variable clinical response.
AuthorsAndrea Naranjo, Jaime D Martinez, Darlene Miller, Rahul Tonk, Guillermo Amescua
JournalOcular immunology and inflammation (Ocul Immunol Inflamm) Vol. 29 Issue 7-8 Pg. 1576-1584 (Nov 17 2021) ISSN: 1744-5078 [Electronic] England
PMID32469616 (Publication Type: Case Reports, Journal Article)
Chemical References
  • Antiprotozoal Agents
  • Phosphorylcholine
  • miltefosine
Topics
  • Acanthamoeba Keratitis (diagnosis, drug therapy, etiology)
  • Administration, Oral
  • Adolescent
  • Adult
  • Antiprotozoal Agents (therapeutic use)
  • Contact Lenses (adverse effects)
  • Female
  • Follow-Up Studies
  • Humans
  • Keratoplasty, Penetrating
  • Middle Aged
  • Phosphorylcholine (analogs & derivatives, therapeutic use)
  • Retrospective Studies
  • Risk Factors
  • Visual Acuity (physiology)
  • Young Adult

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