Acanthamoeba keratitis treatment outcomes compared for drug delivery by protocol versus physician’s individualised treatment
Acanthamoeba keratitis treatment outcomes compared for drug delivery by protocol versus physician’s individualised treatment
Purpose
To compare Acanthamoeba keratitis (AK) outcomes for treatment delivered using a detailed protocol versus physician’s individualised treatment.
Methods
This double cohort study compared the outcomes of these different delivery methods for PHMB 0.02% and diamidine 0.1% dual therapy. The primary outcome was the medical cure rate without surgery within 12 months (MCR_12) and the secondary was visual acuity. Any change of treatment, any surgery, or treatment for >12 months was a failure. Outcomes were both unadjusted and adjusted, using multivariable analysis, for baseline differences affecting outcomes. Patients were from two centres in Milan and London treated at different times; the individualised cohort (1991-2012) and per-protocol cohort (2017-2021).
Results
The individualised cohort included 96 and the per-protocol 47 patients. Both unadjusted and adjusted results were similar. The unadjusted outcomes for both centres combined showed significantly improved outcomes for per-protocol treatment with a 1.59-fold improvement in MCR_12 (95% CI 1.40 - 1.80, p < 0.001) and a 2.1-fold increase in visual acuity ≥ 20/25 (95% CI 1.34 - 3.29, p < 0.001). Amongst potential confounding factors examined, neither baseline AK disease stage, treatment centre nor the type of diamidine significantly influenced outcomes.
Conclusions
This study shows significant advantages for the use of protocol delivered versus individualised treatment for AK. The use of evidence-based treatment delivery protocols, like the one used here for AK, might improve outcomes for all causes of microbial keratitis and could offer practitioners and patients the benefit of having an easy-to-follow drug delivery protocol, with known outcomes.
132-141
Hossain, Parwez
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Dart, John K.G.
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Papa, Vincenzo
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Rama, Paolo
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Knutsson, Karl Anders
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Ahmad, Saj
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Hau, Scott
8aa793e0-b71c-47df-afe1-d09816af4095
Sanchez, Sara
205826c1-236f-4747-94ff-928c96e7d716
Franch, Antonella
a39774eb-7c9d-4d2d-afa8-268893be0f6a
Birattari, Federica
f58e9d34-750e-4627-b623-536f9ef8417c
Leon, Pia
75ef62ce-aabc-4b0d-b652-e762df68cd57
Fasolo, Adriano
7d98c12e-f275-46ea-a752-633866874e0e
Mrukwa-Kominek, Ewa
a7069cc1-c1eb-4fa4-9355-707d046c454b
Jadczyk-Sorek, Katarzyna
88982015-4204-4064-acff-56afef3b5f7f
Carley, Fiona
fe19703d-9b0e-4da8-8287-233d0c158ef1
Hossain, Parwez
563de5fc-84ad-4539-9228-bde0237eaf51
Minassian, Darwin C.
302ba55b-7bd5-44c3-a4fb-859e16650046
15 July 2025
Hossain, Parwez
563de5fc-84ad-4539-9228-bde0237eaf51
Dart, John K.G.
70d82991-bee4-4c45-abfa-5f2516165e71
Papa, Vincenzo
67852436-66f6-4330-8c4e-622b5f935cdd
Rama, Paolo
4758a5b6-577b-41ad-b9e2-b815d1922f97
Knutsson, Karl Anders
4788450c-5444-41ec-be8d-adaf945958d9
Ahmad, Saj
31a2204f-d779-4887-a2ba-74a8f7da3a80
Hau, Scott
8aa793e0-b71c-47df-afe1-d09816af4095
Sanchez, Sara
205826c1-236f-4747-94ff-928c96e7d716
Franch, Antonella
a39774eb-7c9d-4d2d-afa8-268893be0f6a
Birattari, Federica
f58e9d34-750e-4627-b623-536f9ef8417c
Leon, Pia
75ef62ce-aabc-4b0d-b652-e762df68cd57
Fasolo, Adriano
7d98c12e-f275-46ea-a752-633866874e0e
Mrukwa-Kominek, Ewa
a7069cc1-c1eb-4fa4-9355-707d046c454b
Jadczyk-Sorek, Katarzyna
88982015-4204-4064-acff-56afef3b5f7f
Carley, Fiona
fe19703d-9b0e-4da8-8287-233d0c158ef1
Hossain, Parwez
563de5fc-84ad-4539-9228-bde0237eaf51
Minassian, Darwin C.
302ba55b-7bd5-44c3-a4fb-859e16650046
Hossain, Parwez, Dart, John K.G., Papa, Vincenzo, Rama, Paolo, Knutsson, Karl Anders, Ahmad, Saj, Hau, Scott, Sanchez, Sara, Franch, Antonella, Birattari, Federica, Leon, Pia, Fasolo, Adriano, Mrukwa-Kominek, Ewa, Jadczyk-Sorek, Katarzyna, Carley, Fiona, Hossain, Parwez and Minassian, Darwin C.
(2025)
Acanthamoeba keratitis treatment outcomes compared for drug delivery by protocol versus physician’s individualised treatment.
The Ocular Surface, 38, .
(doi:10.1016/j.jtos.2025.03.008).
Abstract
Purpose
To compare Acanthamoeba keratitis (AK) outcomes for treatment delivered using a detailed protocol versus physician’s individualised treatment.
Methods
This double cohort study compared the outcomes of these different delivery methods for PHMB 0.02% and diamidine 0.1% dual therapy. The primary outcome was the medical cure rate without surgery within 12 months (MCR_12) and the secondary was visual acuity. Any change of treatment, any surgery, or treatment for >12 months was a failure. Outcomes were both unadjusted and adjusted, using multivariable analysis, for baseline differences affecting outcomes. Patients were from two centres in Milan and London treated at different times; the individualised cohort (1991-2012) and per-protocol cohort (2017-2021).
Results
The individualised cohort included 96 and the per-protocol 47 patients. Both unadjusted and adjusted results were similar. The unadjusted outcomes for both centres combined showed significantly improved outcomes for per-protocol treatment with a 1.59-fold improvement in MCR_12 (95% CI 1.40 - 1.80, p < 0.001) and a 2.1-fold increase in visual acuity ≥ 20/25 (95% CI 1.34 - 3.29, p < 0.001). Amongst potential confounding factors examined, neither baseline AK disease stage, treatment centre nor the type of diamidine significantly influenced outcomes.
Conclusions
This study shows significant advantages for the use of protocol delivered versus individualised treatment for AK. The use of evidence-based treatment delivery protocols, like the one used here for AK, might improve outcomes for all causes of microbial keratitis and could offer practitioners and patients the benefit of having an easy-to-follow drug delivery protocol, with known outcomes.
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Accepted/In Press date: 31 March 2025
e-pub ahead of print date: 7 April 2025
Published date: 15 July 2025
Identifiers
Local EPrints ID: 502078
URI: http://eprints.soton.ac.uk/id/eprint/502078
ISSN: 1542-0124
PURE UUID: 63de004e-005c-4c9c-9325-0f134bec5bac
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Date deposited: 16 Jun 2025 16:40
Last modified: 04 Sep 2025 02:08
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Contributors
Author:
John K.G. Dart
Author:
Vincenzo Papa
Author:
Paolo Rama
Author:
Karl Anders Knutsson
Author:
Saj Ahmad
Author:
Scott Hau
Author:
Sara Sanchez
Author:
Antonella Franch
Author:
Federica Birattari
Author:
Pia Leon
Author:
Adriano Fasolo
Author:
Ewa Mrukwa-Kominek
Author:
Katarzyna Jadczyk-Sorek
Author:
Fiona Carley
Author:
Darwin C. Minassian
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