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76 EW CORNEA Increasing continued from page 74 to anti-amoebic therapy. "Over the 9½-year period, the number of [cases] diagnosed was relatively con- stant, with only a modest increase seen in 2006–2007," the investiga- tors wrote. The most common risk factor (in 89.7% of cases) was cosmetic contact lens wear. The three eyes not associated with contact lens wear had other factors, such as occupa- tional exposure to freshwater fish tanks, recreational exposure to fresh- water fishing, and one of unknown causes. Twenty-five patients had a full treatment course. All patients were treated with topical anti-amoebic agents, and a majority also used anti-fungal treatment. Twenty per- cent of cases had a recurrence of Acanthamoeba. Eight patients re- ceived a PK. Some patients experi- enced other complications, such as cataract (3 of 28 cases) and glau- coma (6 of 28 cases). Treatment implications Early diagnosis is crucial when treat- ing Acanthamoeba keratitis, Dr. Colby said. "Our data revealed that patients who presented with good VA more often retained useful vision compared with those with poor ini- tial VA," she and Dr. Tanhehco wrote. Dr. Jeng also found that early diagnosis tended to lead to better outcomes. It's also important to consider common misdiagnoses, such as her- pes simplex virus (HSV), Dr. Jeng said. "Because of the overlap in clini- cal findings with HSV and [Acan- thamoeba], patients with epithelial dendritiform lesions or hazy stromal infiltrates are often empirically treated with anti-viral agents and corticosteroid eye drops upon pres- entation … One distinguishing fea- ture of [Acanthamoeba] from HSV keratitis, however, is the overwhelm- ing risk factor of [contact lens] wear only in the former, which was seen in 89.7% of our patients, consistent with the rate of 75–100% of cases in other studies," Dr. Jeng and co-in- vestigators wrote. Both Dr. Colby and Dr. Jeng cited the studies that tracked Acan- thamoeba keratitis incidence in Chicago, work that often involved Elmer Tu, M.D., associate professor of clinical ophthalmology, and director of the Cornea Service, University of Illinois at Chicago. The outbreak there and in other cities was suspected to be linked to the use of the Complete Moisture- Plus solution and, in Chicago, a re- duction in the allowable amount of carcinogenic disinfection bybroducts in the city's water supply. Dr. Tu said the findings of the THE BEST OF BOTH WORLDS for surgical eval into a single measure Only the GALILEI G Only the GALILEI G2 merges the Placido and Dual Scheimpflug Technologies into a single measurement. The combined data provide highly accurate values for surgical evaluation and planning, leading to unrivalled clinical results uation and planning, leading to unrivalled clinical results ement. The combined data provide highly accurate values 2 merges the Placido and Dual S THE BES T OF BOTH WORLDS Scheimpflug T unrivalled clinical results de highly accurate values echnologies Massachusetts study are similar to those found in his study, although the numbers in Massachusetts were smaller. "It is hard to infer, however, whether the total number of cases was increased in each locality be- cause there are multiple institutions that see these patients in each city," Dr. Tu said. He believes that the Acanthamoeba incidence in Chicago has been relatively static for the past 2 years. Dr. Tu also had an article in the September issue of Cornea regarding the use of voriconazole in chronic stromal Acanthamoeba keratitis. To help prevent Acanthamoeba, Dr. Colby recommends that patients use daily disposable contact lenses if their prescription allows it. She also prefers that patients use a hydrogen peroxide cleaning solution instead of a multipurpose cleaning solution. Regularly replacing contact lens storage cases may also help reduce contamination, Dr. Colby said. EW Editors' note: The doctors mentioned have no financial interests related to this article. Move to the next level of accuracy in Anterior Segment Tomography Ziemer USA, Inc. 321 Ridge Street, Al ton, IL 62002, USA Ridge Street, Alton, IL 62002, USA about ho 86 Call 1-866- about how GALILEI G2 can improve outcomes for your patients 66-708-4490 or visit www.ziemergroup.com for further information w GALILEI G2 can improve outcomes for your patients your patients m for further information Contact Information Colby: kacolby@meei.harvard.edu Jeng: jengb@vision.ucsf.edu Tu: 847-571-3966, etu@uic.edu March 2012