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Title

Acanthamoeba keratitis in the Antwerp University Hospital: a review of diagnosis, follow-up and clinical outcomes.

Purpose	To assess the diagnosis, follow-up and outcomes of patients with AK at the Antwerp University Hospital.
Methods	Retrospective analysis of all cases diagnosed with a presumed AK at the Antwerp University Hospital between September 2016 and August 2018. Cases were identified using clinical, laboratory and pharmacy records. Results of in vivo confocal microscopy (IVCM), corneal scrape cultures and clinical outcomes were analyzed
Results	13 eyes of 12 patients were diagnosed with AK. The mean duration from start of the symptoms to diagnosis was 33 days. IVCM was performed in 10 of the 13 eyes and corneal scrape cultures in 11 of the 13 eyes. Diagnosis was made using IVCM in 80%, corneal scrape in 23%, and clinically in 15%. In 14% of the patients with confirmed cyst structures using IVCM, the culture was positive. In 62 % of patients, IVCM was applied for monitoring and/or guidance of treatment. Surgical intervention was required in 4 of the 13 eyes. There was an improvement of visual outcome in 85%, with a best corrected visual acuity (BCVA) of >0.8 in 69 % of the eyes. In 23% of the eyes was the BCVA at the end of treatment <0,2.
Conclusion	IVCM is useful in diagnosis of AK, especially when cultures are not available of negative. It allows for a rapid diagnosis and can be used to monitor treatment response, allowing guidance to clinicians for management. Although AK is vision-threatening condition, we report favorable visual outcomes under combined therapy with chlorhexidine, propamidine isethionate and polyhexamethylene biguanide.
Conflict of interest	No

Authors 1

Last name	CHIAIRI
Initials	I
Department	Antwerp University Hospital
City	Antwerp

Authors 2

Last name	Behaegel
Initials	J
Department	Antwerp University Hospital
City	Antwerp