International Ophthalmology

, Volume 39, Issue 12, pp 2889–2896 | Cite as

Therapeutic penetrating keratoplasty for acanthamoeba keratitis: a review of cases, complications and predictive factors

  • Mehdi RoozbahaniEmail author
  • Kristin M. Hammersmith
  • Christopher J. Rapuano
  • Parveen K. Nagra
  • Qiang Zhang
Original Paper



To review 12 acanthamoeba keratitis (AK) patients who required a therapeutic penetrating keratoplasty (TPK) and determine whether there are factors at the presenting visit that can predict the need for TPK.

Materials and methods

This was a retrospective case series. All diagnosed AK patients between January, 2009 and February, 2016 at Wills Eye Hospital, Philadelphia, PA, USA, were enrolled. Information regarding demographics, disease manifestation, management and complications was collected. Potential predictors for TPK were obtained by comparing TPK cases with those who were treated medically.


Sixty-three eyes from 63 patients were diagnosed with AK. Twelve eyes (19%) required TPK during the course of treatment, and 51 eyes (81%) were treated medically. Reasons for performing TPK included medically non-responsive ulcer in seven eyes (58%), perforated ulcer in three eyes (25%) and significant corneal thinning in two eyes (17%). The most common post-TPK complications included graft failure (75%), cataract (50%) and uncontrolled glaucoma required glaucoma surgery (17%). Reactivation of AK was seen in one (8%) patient. Anti-amoebic treatment beginning after 25 days from the start of AK symptoms [odds ratio (OR) = 7.63; confidence interval (CI) = 1.01–55.33; p = 0.041] and poorer presenting vision (OR = 5.42; CI = 1.91–15.36; p = 0.002) were independent predictors of the need for TPK in multivariate analysis.


TPK is a procedure with significant postoperative complications but is required by some patients with AK. Eyes with higher risk for needing TPK can be identified earlier and thus provided more intensive treatment and closer follow-up care.


Acanthamoeba keratitis Therapeutic penetrating keratoplasty Predictive factors Corneal ulcer 


Compliance with ethical standards

Conflict of interest

There is no conflict of interest to declare.


  1. 1.
    Clarke B, Sinha A, Parmar DN, Sykakis E (2012) Advances in the diagnosis and treatment of acanthamoeba keratitis. J Ophthalmol. CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Maycock NJ, Jayaswal R (2016) Update on acanthamoeba keratitis: diagnosis, treatment, and outcomes. Cornea 35:713–720CrossRefGoogle Scholar
  3. 3.
    Carnt N, Robaei D, Minassian DC, Dart JKG (2018) Acanthamoeba keratitis in 194 patients: risk factors for bad outcomes and severe inflammatory complications. B J Ophthalmol 102:1431–1435CrossRefGoogle Scholar
  4. 4.
    Chew HF, Yildiz EH, Hammersmith KM, Eagle RC Jr, Rapuano CJ, Laibson PR et al (2011) Clinical outcomes and prognostic factors associated with acanthamoeba keratitis. Cornea 30:435–441CrossRefGoogle Scholar
  5. 5.
    Jiang C, Sun X, Wang Z, Zhang Y (2015) Acanthamoeba keratitis: clinical characteristics and management. Ocular Surf 13:164–168CrossRefGoogle Scholar
  6. 6.
    Robaei D, Carnt N, Minassian DC, Dart JK (2014) The impact of topical corticosteroid use before diagnosis on the outcome of acanthamoeba keratitis. Ophthalmology 121:1383–1388CrossRefGoogle Scholar
  7. 7.
    Robaei D, Carnt N, Minassian DC, Dart JK (2015) Therapeutic and optical keratoplasty in the management of acanthamoeba keratitis: risk factors, outcomes, and summary of the literature. Ophthalmology 122:17–24CrossRefGoogle Scholar
  8. 8.
    Bouheraoua N, Gaujoux T, Goldschmidt P, Chaumeil C, Laroche L, Borderie VM (2013) Prognostic factors associated with the need for surgical treatments in acanthamoeba keratitis. Cornea 32:130–136CrossRefGoogle Scholar
  9. 9.
    Awwad ST, Parmar DN, Heilman M, Bowman RW, McCulley JP, Cavanagh HD (2005) Results of penetrating keratoplasty for visual rehabilitation after acanthamoeba keratitis. A J Ophthalmol 140:1080–1084CrossRefGoogle Scholar
  10. 10.
    Kitzmann AS, Goins KM, Sutphin JE, Wagoner MD (2009) Keratoplasty for treatment of acanthamoeba keratitis. Ophthalmology 116:864–869CrossRefGoogle Scholar
  11. 11.
    Chen WL, Wu CY, Hu FR, Wang IJ (2004) Therapeutic penetrating keratoplasty for microbial keratitis in Taiwan from 1987 to 2001. A J Ophthalmol 137:736–743Google Scholar
  12. 12.
    Kashiwabuchi RT, de Freitas D, Alvarenga LS, Vieira L, Contarini P, Sato E et al (2008) Corneal graft survival after therapeutic keratoplasty for acanthamoeba keratitis. Acta Ophthalmol 86:666–669CrossRefGoogle Scholar
  13. 13.
    McClellan K, Howard K, Niederkorn JY, Alizadeh H (2001) Effect of steroids on acanthamoeba cysts and trophozoites. Invest Ophthalmol Visual Sci 42:2885–2893Google Scholar
  14. 14.
    Bajracharya L, Gurung R (2015) Outcome of therapeutic penetrating keratoplasty in a tertiary eye care center in Nepal. Clin Ophthalmol 9:2299–2304CrossRefGoogle Scholar
  15. 15.
    Lim LS, Arundhati A, Tan DT (2011) Sequential therapeutic penetrating keratoplasty with cryopreserved and fresh corneal tissue for severe infectious keratitis: a case-control study. Cornea 30:739–743CrossRefGoogle Scholar
  16. 16.
    Liu Y, Jia H, Shi X, Wang J, Ning Y, He B et al (2013) Minimal trephination penetrating keratoplasty for severe fungal keratitis complicated with hypopyon. Can J Ophthalmol 48:529–534CrossRefGoogle Scholar
  17. 17.
    Ti SE, Scott JA, Janardhanan P, Tan DT (2007) Therapeutic keratoplasty for advanced suppurative keratitis. A J Ophthalmol 143:755–762CrossRefGoogle Scholar
  18. 18.
    Shimazaki J, Iseda A, Satake Y, Shimazaki-Den S (2012) Efficacy and safety of long-term corticosteroid eye drops after penetrating keratoplasty: a prospective, randomized, clinical trial. Ophthalmology 119:668–673CrossRefGoogle Scholar
  19. 19.
    Huang P, Tepelus T, Vickers LA, Baghdasaryan E, Huang J, Irvine JA et al (2017) Quantitative analysis of depth, distribution, and density of cysts in acanthamoeba keratitis using confocal microscopy. Cornea 36:927–932CrossRefGoogle Scholar
  20. 20.
    Sun Y, Hong J, Zhang P, Peng R, Xiao G (2013) Pathological characteristics of the different stages of acanthamoeba keratitis. Histopathology 63:862–868CrossRefGoogle Scholar
  21. 21.
    Lorenzo-Morales J, Khan NA, Walochnik J (2015) An update on acanthamoeba keratitis: diagnosis, pathogenesis and treatment. Parasite 22:10CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  • Mehdi Roozbahani
    • 1
    Email author
  • Kristin M. Hammersmith
    • 1
  • Christopher J. Rapuano
    • 1
  • Parveen K. Nagra
    • 1
  • Qiang Zhang
    • 2
  1. 1.Cornea Service, Wills Eye Hospital, Sidney Kimmel Medical CollegeThomas Jefferson UniversityPhiladelphiaUSA
  2. 2.Vision Research Center, Wills Eye Hospital, Sidney Kimmel Medical CollegeThomas Jefferson UniversityPhiladelphiaUSA

Personalised recommendations