Eyeworld

NOV 2012

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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64 EW CORNEA Acanthamoeba continued from page 62 Dr. Keenan was a little surprised that approximately 62% of respon- dents used steroids as part of their regimen here. "[There is a] sense anecdotally that a lot of people would never use steroids," he said. "But according to the survey, people are using steroids for Acanthamoeba." Dr. Tu pointed to a landmark paper by John Dart, published in the American Journal of Ophthalmology in 2009, which touted steroid use. "He probably has had the most clinical and research experience with Acan- thamoeba keratitis at Moorfields Eye Hospital, where they use steroids routinely in patients who need them as long as they're under effective treatment," he said. "So 60% seems high if you're talking about infec- tions, but in this particular disorder, because it's chronic and inflamma- tion is a major component, [there is] some penetration of that paper as far as the thinking and use of steroids in Acanthamoeba." In addition, the survey pointed out the surprisingly common use of corneal transplantation in many of these cases. "There has been an extremely strong bias in Acanthamoeba keratitis, specifically that this is not a good option unless the patient is about to lose the eye," Dr. Tu said. "Now that we have more effective medications, I think that there's mounting evidence that corneal transplantation can be help- ful in certain patients at an earlier stage." He pointed out that the study showed that nearly three- fourths of practitioners feel that use of transplantation is an option at some point. However, most reserve this for very late cases. "We found that 85% would only perform the surgery after medical therapy had failed," he said. Dr. Keenan thinks that the study helps show from a clinical perspec- tive that there are currently many different practices for treating Acanthamoeba keratitis. "I think that it helps clinicians to see what other people are doing—that there really isn't a norm," he said. "To me, it highlights that there isn't good evidence about Acanthamoeba," Dr. Keenan said. Ms. Oldenburg agreed. "I think ª5$7# that it's interesting that there was a lot of uncertainty of what the best practice patterns are and that people answered in many different ways," she said. Going forward, Dr. Tu stressed that, unfortunately, the Acan- thamoeba outbreak that started in 2003 does not appear to be receding. "It resulted in a recall of a contact lens solution back in 2007," he said. "But because of persistence of the very elevated levels versus the historical controls here in the U.S., the [Centers for Disease Control and Prevention] had to conduct another study this year because recalling the solution didn't take care of the en- tire problem." He sees practitioners as having to continue to deal with this indefinitely. "Acanthamoeba continues as a significant problem, and we'll see it at heightened levels for some time." EW Editors' note: The physicians and Ms. Oldenburg have no financial interests related to this article. www.myreg gistration.net/woc2014_r_ g eg Join us April 2-6, 2014 www www.fa www.facebook.com/woc2014 w..woc2014.org c2014 twitter.c. om/woc2014 Contact information Keenan: 415-476-6323, Jeremy.keenan@ucsf.edu Oldenburg: 415-514-2163, Catherine.oldenbur@ucsf.edu Tu: 847-571-3966, etu@uic.edu November 2012

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