Topical 2% Cyclosporine is Effective in Controlling the Inflammation and Improving the Treatment Outcome in Patients with Acanthamoeba Keratitis
Matteo Posarelli1,2 and Pedram Hamrah1,2
1Cornea Service, Department of Ophthalmology, Tufts Medical Center, Tufts School of Medicine, Boston, Massachusetts;
2Center for Translational Ocular Immunology, Department of Ophthalmology, Tufts Medical Center, Tufts School of Medicine,
Purpose: Acanthamoeba keratitis (AK) is a rare but severe corneal infection that can potentially lead to blindness. Conventional treatments aim to eradicate trophozoytes and cysts from the cornea, but sometimes the associated severe inflammation can worsen the corneal damage and delay the healing process.
Purpose: To evaluate the outcome of using topical 2% cyclosporine to limit the corneal inflammation in Acanthamoeba keratitis patients.
Methods: Retrospective case-series of patients with Acanthamoeba keratitis and severe corneal inflammation assessed by in vivo confocal microscopy (IVCM) that received topical 2% cyclosporine in addition to their standard therapy with biguanides (PHMB and chlorhexidine) and voriconazole.
Results: Three male and three female patients (n=6), with a mean age of 34.6±7.8 years, were included. The mean follow-up duration was 4.3±0.2 months (range 6-2). After treatment, BCVA increased from 1.02±0.3 to 0.4±0.2 logMAR (p<0.05), 3 patients had complete epithelial healing, and 3 showed improvement in corneal staining. Further, corneal inflammatory cell density significantly decreased from 471.8±61 to 93.75±17.23 cells/mm2.
Conclusions: In patients with Acanthamoeba keratitis, the use of topical 2% cyclosporine as additional therapy can help in limiting the burden of corneal inflammation, promoting the epithelial healing, and improving the treatment outcome.
Support: NIH-1R61NS113341, Lions Club International Foundation, Massachusetts Lions Eye Research Fund, Inc., Research to Prevent Blindness Challenge Grant (Hamrah)