Systemic Miltefosine as an Adjunct Treatment of Progressive Acanthamoeba Keratitis

Andrea Naranjo, Jaime D. Martinez, Darlene Miller, Rahul Tonk, Guillermo Amescua

Research output: Contribution to journalArticle

Abstract

Purpose: To report our experience with oral miltefosine (MLT) as an adjunct treatment for progressive Acanthamoeba keratitis (AK). Methods: Retrospective case series of all patients who underwent treatment with oral MLT for AK at Bascom Palmer Eye Institute from 2017 to 2020. Results: Six females from 16 to 55 years old, with a microbiologic diagnosis of Acanthamoeba, were treated with MLT and standard medical treatment. Four of the six cases deteriorated after initiating treatment and three required a therapeutic keratoplasty. Two patients improved after 1 week of MLT and optical penetrating keratoplasty was performed after clinical resolution. Microbiologic culture of corneal buttons was negative in all cases. All corneal grafts remain clear at last follow-up with best-corrected visual acuity of 20/40 or better. Conclusion: Oral MLT may be a viable adjunctive therapy for recalcitrant AK; however, its use may be associated with a severe inflammatory reaction. Further studies are needed to evaluate its efficacy and variable clinical response.

Original languageEnglish (US)
JournalOcular Immunology and Inflammation
DOIs
StateAccepted/In press - 2020

Keywords

  • Acanthamoeba
  • Cornea
  • impavido
  • infectious keratitis
  • miltefosine

ASJC Scopus subject areas

  • Immunology and Allergy
  • Ophthalmology

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