Resolution of Acanthamoeba Keratitis with Adjunctive Use of Oral Miltefosine

ABSTRACT

Purpose: To report a series of cases demonstrating the resolution of Acanthamoeba keratitis (AK) with adjunctive use of oral miltefosine.

Methods: Retrospective case series.

Results: The first case was a 27-year-old female who presented with severe pain and photophobia. The diagnosis of AK was made with confocal microscopy, which revealed a significant burden of stromal cysts. After approximately 2 weeks of adjunctive oral miltefosine therapy, there was a severe inflammatory response within the cornea followed by quick resolution of the AK. The second case was a 31-year-old male in whom the diagnosis of AK was confirmed by culture and polymerase chain reaction. Adjunctive oral miltefosine was started 3 months after presentation, leading to a quick resolution.

Conclusions: Oral miltefosine may have cysticidal properties and should be considered as adjunctive therapy for the treatment of AK, particularly in cases with a significant burden of cysts or in cases recalcitrant to other treatments.

KEYWORDS:

• Acanthamoeba keratitis
• miltefosine
• contact lens use
• confocal microscopy
• infectious keratitis

Declaration of interest

Asim V. Farooq, MD is a consultant to GlaxoSmithKline. The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Patient consent

Informed consent was obtained from the patients for the use of their health information. No IRB approval was obtained for this report.