Journal article
Oral Miltefosine as Salvage Therapy for Refractory Acanthamoeba Keratitis
American journal of ophthalmology, Vol.223, pp.75-82
03/2021
DOI: 10.1016/j.ajo.2020.09.048
PMID: 33045218
Abstract
To report a case series of patients with treatment-resistant Acanthamoeba keratitis (AK) using oral miltefosine, often as salvage therapy.
Descriptive, retrospective multicenter case series.
We reviewed 15 patients with AK unresponsive to therapy who were subsequently given adjuvant systemic miltefosine between 2011 and 2017. The main outcome measures were resolution of infection, final visual acuity, tolerance of miltefosine, and clinical course of disease.
All patients were treated with biguanides and/or diamidines or azoles without resolution of disease before starting miltefosine. Eleven of 15 patients retained count fingers or better vision, and all were considered disease free at last follow-up. Eleven of 15 patients had worsening inflammation with miltefosine, with 10 of them improving with steroids. Six patients received multiple courses of miltefosine. Most tolerated oral miltefosine well, with mild gastrointestinal symptoms as the most common systemic side effect.
Oral miltefosine is a generally well-tolerated treatment adjuvant in patients with refractory AK. The clinician should be prepared for a steroid-responsive inflammatory response frequently encountered during the treatment course.
Details
- Title: Subtitle
- Oral Miltefosine as Salvage Therapy for Refractory Acanthamoeba Keratitis
- Creators
- Praneetha Thulasi - Emory Eye CenterHajirah N. Saeed - Massachusetts Eye and Ear InfirmaryChristopher J. Rapuano - Wills Eye HospitalJoshua H. Hou - University of MinnesotaAlpheus B. Appenheimer - Iowa City VA Health Care SystemJames Chodosh - Massachusetts Eye and Ear InfirmaryJoann J. Kang - Montefiore Medical CenterAmber M. Morrill - Dartmouth CollegeNeil Vyas - Regional Medical CenterMichael E. Zegans - Dartmouth CollegeRichard Zuckerman - Dartmouth CollegeElmer Y. Tu - University of Illinois at Chicago
- Resource Type
- Journal article
- Publication Details
- American journal of ophthalmology, Vol.223, pp.75-82
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.ajo.2020.09.048
- PMID
- 33045218
- ISSN
- 0002-9394
- eISSN
- 1879-1891
- Grant note
- DOI: 10.13039/100001818, name: Research to Prevent Blindness; DOI: 10.13039/100000053, name: National Eye Institute; DOI: 10.13039/100000038, name: U.S. Food and Drug Administration
- Language
- English
- Date published
- 03/2021
- Academic Unit
- Infectious Diseases; Internal Medicine
- Record Identifier
- 9984359667502771
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