This retrospective study was done to study the clinical presentation and microbiological results of non-contact-lens-related acanthamoeba keratitis (AK). One hundred and ninety-four patients with microbiological / histopathological diagnosis of AK over four years were included. All patients had corneal scrapings directly inoculated onto sheep blood agar, chocolate agar, non-nutrient agar, sabouraud dextrose agar, potato dextrose agar, thioglycollate and brain-heart infusion broth. Smears were evaluated with Gram stain, Geimsa stain and potassium hydroxide with calcofluor white stain. The excised corneal button in patients who underwent keratoplasty was divided into two halves for microbiological and histopathological processing. Sixty-five percent of patients presented with anterior stromal infiltration, which included 25.8% of ring infiltrates, 17.25% of multiple stromal imfiltrates. Smear examination was positive in 82% cases on first scraping and 98% on repeat scrapings. Mean age of patients with AK was 38.5 years. History of swimming in open pond or trauma with vegetative matter was seen in 43.3% of cases. There was no statistically significant difference in clinical presentation of patients presenting early or late. The authors conclude that repeated scrapings can yield a definitive microbiological diagnosis and they are a reliable diagnostic modality. The limitations of this study are the exclusion of patients with a had clinical diagnosis of AK but not proved by microbiology or histopathology. This article is a good summary of presentation of non-contact lens related AK in a developing country and reiterates the important role of inexpensive investigations like corneal scraping for smears and culture in AK.

Clinico-microbiological review of non-contact-lens-associated Acanthameoba keratitis.
Jain R, Garg P, Motukupally SR, Geary MB.
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Jaya Myneni

Royal Liverpool University Hospitals, UK.

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