Elsevier

Ophthalmology

Volume 118, Issue 2, February 2011, Pages 324-331
Ophthalmology

Original article
Riboflavin and Ultraviolet Light A Therapy as an Adjuvant Treatment for Medically Refractive Acanthamoeba Keratitis: Report of 3 Cases

Presented at: The American Academy of Ophthalmology Annual Meeting, November 2008, San Francisco, California.
https://doi.org/10.1016/j.ophtha.2010.06.041Get rights and content

Purpose

To present the first 3 cases of Acanthamoeba keratitis (AK), unresponsive to medical treatment, that were successfully treated with a novel adjunctive therapy using ultraviolet light A (UVA) and riboflavin (B2).

Design

Interventional case series.

Participants

Two patients with confirmed AK and 1 patient with presumptive AK, which were all refractive to multidrug conventional therapy.

Intervention

Two treatment sessions involving topical application of 0.1% B2 solution to the ocular surface combined with 30 minutes of UVA irradiation focused on the corneal ulcer.

Main Outcome Measures

Clinical examination by slit lamp, confocal microscopy, and histopathology, when available.

Results

All patients in these series showed a rapid reduction in their symptoms and decreased ulcer size after the first treatment session. The progress of the clinical improvement began to slow after 1 to 3 weeks of the first application and was then renewed after the second application. All ancillary signs of inflammation mostly resolved after the second treatment session. The ulcers in all patients continued to decrease and were closed within 3 to 7 weeks of the first application. Two patients developed dense central corneal scars, and penetrating keratoplasty was performed for visual rehabilitation. Histopathologic examination of the excised tissue revealed no Acanthamoeba organisms. The remaining patient had no symptoms or signs of infection, both clinically and by confocal microscopy, and was left with a semitransparent eccentric scar that did not affect visual acuity.

Conclusions

The adjunctive use of UVA and B2 therapy seems to be a possible alternative for selected cases of medication-resistant AK.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found after the references.

Section snippets

Materials and Methods

The institutional review board of The Johns Hopkins University, Baltimore, Maryland, granted individual emergency therapeutic use approval for the treatment to be conducted on patients 1 and 2 of this series. Similar approval was obtained for patient 3 from the institutional review board of Instituto de Cirugía Ocular in San Jose, Costa Rica. Because this is a non-approved treatment of microbial keratitis in the United States, the US Food and Drug Administration authorized the emergent use of

Results

The clinical resolution of AK in these series was determined by improvement of symptoms, decreased ulcer size, reduction in signs of infection, and histopathology. Notably, all patients reported considerable pain within the first 48 hours after the application of the UVA/B2 treatment. However, this was followed by a dramatic decrease in pain and photophobia after 3 days of the UVA and B2 treatment, with no significant exacerbations of symptoms. The ulcers in all patients were visibly decreasing

Discussion

The patients presented in this report were of different ages and races, and from different geographic locations. They used different brands of contact lenses and lens care products. The only commonality between them illustrates a salient point about AK: Improper contact lens use and hygiene remain the most important risk factors for developing the infection.8 Patient 1 reported extended and periodic overnight wear of his contact lenses before his symptom onset.9 Patients 2 and 3 reported

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  • Cited by (0)

    Manuscript no. 2010-96.

    Financial Disclosure(s): The author(s) have made the following disclosure(s): Dr. Behrens is a patent owner for a wearable device that uses this photochemical therapy to treat infectious keratitis. The authors have no financial interests in the products described in this manuscript.

    Funding: National Institutes of Health Small Business Innovation Research Grant R44EY015955-02S1; Research to Prevent Blindness (New York, NY); Fight for Sight (New York, NY).

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